MEDICARE: TERESA ANN RYMAN BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1194564641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN RYMAN BS

Provider Business Mailing Address
First Line	:	714A SCHOOL AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-5151
Country	:	US
Telephone Number	:	620-287-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 W 23RD ST BLDG E-40
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3923
Country	:	US
Telephone Number	:	850-747-5411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/23/2024

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