Provider Demographics
NPI:1730600206
Name:RYAN, AMANDA MARIE (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:GYGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 630001
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80163-0001
Mailing Address - Country:US
Mailing Address - Phone:303-660-6493
Mailing Address - Fax:303-346-9727
Practice Address - Street 1:8853 WAGNER CT
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5244
Practice Address - Country:US
Practice Address - Phone:303-660-6493
Practice Address - Fax:303-346-9727
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00148462251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149757Medicaid