Provider Demographics
NPI:1023340122
Name:RYAN, CAREY (PT)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21700 SUNNYDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2804
Mailing Address - Country:US
Mailing Address - Phone:586-350-5513
Mailing Address - Fax:
Practice Address - Street 1:24345 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1285
Practice Address - Country:US
Practice Address - Phone:586-563-3300
Practice Address - Fax:586-563-3313
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist