Basic Information
| Provider Information | |||||||||
| NPI: | 1053036707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUICK | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 WICKERSHAM LN APT 1921 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787414673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162708458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10001 S I-35 FRONTAGE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787477874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124400555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1368380 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.