Basic Information
| Provider Information | |||||||||
| NPI: | 1407592066 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITT | ||||||||
| FirstName: | RYAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1837 SWEENEYSBURG RD | ||||||||
| Address2: | |||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258019703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046730519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 152 SADDLESHOP RD | ||||||||
| Address2: | |||||||||
| City: | HILLTOP | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044692966 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2022 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 001424 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.