Basic Information
| Provider Information | |||||||||
| NPI: | 1285712620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 S SALISBURY BLVD | ||||||||
| Address2: | STE 1B | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106770700 | ||||||||
| FaxNumber: | 4106770883 | ||||||||
| Practice Location | |||||||||
| Address1: | 659 S SALISBURY BLVD | ||||||||
| Address2: | STE 1B | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106770700 | ||||||||
| FaxNumber: | 4106770883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0002201 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 21359 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.