Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 20504 | MA |
NPI | 1083021026 |
---|---|
Provider Name | Brianna Ryan |
First Address | Somerville, MA 02144-2950 |
Second Address | Somerville, MA 02144-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 22/07/2014 |