MEDICARE: MRS. ELLEN LOUISE RYAN P.T.

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	225100000X	Physical Therapist	40QA00813600	NJ

General Provider Information

NPI Number	:	1205024056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN LOUISE RYAN P.T.

Provider Business Mailing Address
First Line	:	277 HARRIMAN HEIGHTS RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-3625
Country	:	US
Telephone Number	:	845-238-3019
Fax Number	:

Provider Business Practice Location Address
First Line	:	277 HARRIMAN HEIGHTS RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-3625
Country	:	US
Telephone Number	:	845-238-3019
Fax Number	:

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/24/2024

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