MEDICARE: RYAN MCCORMICK 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	40QA00817800	NJ

General Provider Information

NPI Number	:	1942220934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MCCORMICK P.T.

Provider Business Mailing Address
First Line	:	1072 WHISPERING OAK LN
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-2632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 ATLANTIC CITY BLVD
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-1255
Country	:	US
Telephone Number	:	732-237-7100
Fax Number	:	732-237-3117

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/16/2025

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