Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1208632 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1208632 | TX |
NPI | 1225319452 |
---|---|
Provider Name | Dr. Ryan Lee Ardoin |
First Address | Houston, TX 77030-4211 |
Second Address | Houston, TX 77030-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2011 |
Last Update Date | 12/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1208632 | TX LICENSE (01) | TX |