MEDICARE: SANDRA RYAN

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	225200000X	Physical Therapy Assistant	2098877	TX

General Provider Information

NPI Number	:	1467845958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA RYAN

Provider Business Mailing Address
First Line	:	16447 LAKE LOOP
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78734-2629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16447 LAKE LOOP
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78734-2629
Country	:	US
Telephone Number	:	512-745-1049
Fax Number	:

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

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/09/2015

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Directions to “ SANDRA RYAN ” Practice Location

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