MEDICARE: SEAN CASEY RYAN P.T.

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	PT 29414	CA

General Provider Information

NPI Number	:	1730286410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN CASEY RYAN P.T.

Provider Business Mailing Address
First Line	:	1912 S PACIFIC COAST HWY
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6118
Country	:	US
Telephone Number	:	310-540-5758
Fax Number	:	310-540-5404

Provider Business Practice Location Address
First Line	:	1912 S PACIFIC COAST HWY
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6118
Country	:	US
Telephone Number	:	310-540-5758
Fax Number	:	310-540-5404

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	06/26/2023

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