MEDICARE: JESSICA M RYDER 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	5910	AZ

General Provider Information

NPI Number	:	1649317470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M RYDER PT

Provider Business Mailing Address
First Line	:	4446 N 36TH ST
Second Line	:	APT. 3
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3554
Country	:	US
Telephone Number	:	302-377-3385
Fax Number	:	480-951-6464

Provider Business Practice Location Address
First Line	:	4446 N 36TH ST
Second Line	:	APT. 3
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3554
Country	:	US
Telephone Number	:	302-377-3385
Fax Number	:	480-951-6464

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	02/28/2017

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