Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT008101 | GA |
NPI | 1013132869 |
---|---|
Provider Name | Mr. Edward Davis Ryan |
First Address | Gainesville, GA 30504-2629 |
Second Address | Gainesville, GA 30504-2629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |