Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MT193869 | PA |
Y | 2081S0010X | Sports Medicine | MT193869 | PA |
Y | 213ES0000X | Sports Medicine | MT193869 | PA |
NPI | 1558525030 |
---|---|
Provider Name | Ryan Roza |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 13/08/2020 |