Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT24911 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT24911 | FL |
NPI | 1063747988 |
---|---|
Provider Name | Ryan M Wadas |
First Address | Temple Terrace, FL 33637-0925 |
Second Address | Temple Terrace, FL 33637-0925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2009 |
Last Update Date | 28/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
K3841 | (02) | FL |