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General NPI Number Information
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NPI Number | 1578013785
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Entity Type | Individual
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Provider Name | RYAN MILLOY PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 716 N PARK RD STE 1
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City | WYOMISSING
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State | PA
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Zip | 19610-2912
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Country | US
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Telephone | 610-375-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 415 E WESNER RD
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City | BLANDON
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State | PA
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Zip | 19510-9613
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Country | US
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Telephone | 484-599-1358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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