MEDICARE: RYAN D ZARZYCKI MPT, CERT. MDT

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	J10001771	DE
2	225100000X	Physical Therapist	PT0016711	PA
3	225100000X	Physical Therapist	PT016711	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1729812	OTHER		MAMSI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2397745000	OTHER	DE	AMERIHEALTH

General Provider Information

NPI Number	:	1225070766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN D ZARZYCKI MPT, CERT. MDT

Provider Business Mailing Address
First Line	:	75 EVELYN DRIVE
Second Line	:
City	:	MILLERSBURG
State	:	PA
Zip	:	17061-1258
Country	:	US
Telephone Number	:	717-692-4708
Fax Number	:	717-692-4715

Provider Business Practice Location Address
First Line	:	836 HOUSTON RUN DRIVE
Second Line	:	SUITE 101
City	:	GAP
State	:	PA
Zip	:	17527-9496
Country	:	US
Telephone Number	:	717-442-8957
Fax Number	:	717-442-1063

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

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	11/22/2011

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