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NPI Code Detail

MEDICARE: MR. RYAN CHRISTOPHER NAKUTAVICIUS DPT

MEDICARE: MR. RYAN CHRISTOPHER NAKUTAVICIUS DPT
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
1225100000XPhysical Therapist029312NY

General Provider Information

NPI Number : 1700083318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN CHRISTOPHER NAKUTAVICIUS DPT
Provider Business Mailing Address
First Line : 2403 PARKVIEW PL
Second Line :
City : BALDWIN
State : NY
Zip : 11510-3442
Country : US
Telephone Number : 516-867-9215
Fax Number :
Provider Business Practice Location Address
First Line : 1450 MADISON AVE
Second Line : BOX 1674
City : NEW YORK
State : NY
Zip : 10029-6508
Country : US
Telephone Number : 917-457-0421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 07/08/2007

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