Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 006361 | CT |
NPI | 1063420743 |
---|---|
Provider Name | Ms. Deborah H. Ryan |
First Address | Torrington, CT 06790-3493 |
Second Address | Torrington, CT 06790-3493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080006361CT01 | ANTHEM BCBS (01) | CT |