Basic Information
| Provider Information | |||||||||
| NPI: | 1598762445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYU | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCHUGH | ||||||||
| OtherFirstName: | MAUREEN | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | MPT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 771 PILOT HOUSE DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 6161 KEMPSVILLE CIRCLE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579654890 | ||||||||
| FaxNumber: | 7579654893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 2305005686 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 2305005686 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 192967 | 01 | VA | BCBS PHY THERAPY | OTHER | P00398192 | 01 | VA | RAILROAD MEDICARE | OTHER | 102000 | 01 | VA | ANTHEM BCBS | OTHER | 1598762445 | 05 | VA | MEDICAID | 7003161 | 01 | VA | AETNA | OTHER |