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General NPI Number Information
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NPI Number | 1942083597
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Entity Type | Individual
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Provider Name | RYAN PAUL DPT
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Gender | Male
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 1264 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4929
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Country | US
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Telephone | 616-888-7993
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Fax | 616-432-2924
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Provider Business Mailing Address
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Address Line | 1311 MAMARONECK AVE STE 140
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5224
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Country | US
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Telephone | 914-294-4050
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501302659
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License Number State | MI
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