Michael Ryan, PT, ATC
Physical Therapist in Jacksonville Beach, FL. Individual provider (NPI-1).
NPI number1003367202
StatusActive
Last updated in NPPESOct 23, 2016
Details
- NPI
- 1003367202
- Entity type
- Individual (NPI-1)
- Name
- Michael Ryan
- Credential
- PT, ATC
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 23, 2016
- Last updated
- Oct 23, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | PT15572 | FL | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AL439 | FL |
Practice location
1312 3rd St NJacksonville Beach, FL 32250-7348
Phone 904-465-5277
Mailing address
184 Summerfield DrPonte Vedra Beach, FL 32082-2639
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