Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 036910-1 | NY |
N | 225100000X | Physical Therapist | 20731 | MA |
N | 225100000X | Physical Therapist | 40QA01539700 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 12204PT | AZ |
NPI | 1073915666 |
---|---|
Provider Name | Connor Lee Ryan |
First Address | Chandler, AZ 85225-9040 |
Second Address | Gilbert, AZ 85298-4259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2014 |
Last Update Date | 25/05/2016 |