MEDICARE: MRS. AIMEE MICHELLE RYAN PT

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	4789	KY

General Provider Information

NPI Number	:	1619067337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AIMEE MICHELLE RYAN PT

Provider Business Mailing Address
First Line	:	9404 GARDEN DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-3344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9404 GARDEN DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-3344
Country	:	US
Telephone Number	:	615-478-6797
Fax Number	:	502-261-0699

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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