Basic Information
| Provider Information | |||||||||
| NPI: | 1891243168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDY | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 OLIVE CHAPEL RD | ||||||||
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| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275028586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358758 | ||||||||
| FaxNumber: | 9195353271 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 W GANNON AVE | ||||||||
| Address2: | |||||||||
| City: | ZEBULON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275972623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195515026 | ||||||||
| FaxNumber: | 9196358038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2016 | ||||||||
| LastUpdateDate: | 09/15/2016 | ||||||||
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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 | P16511 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.