Provider Demographics
NPI:1013072743
Name:YOLITZ, RYAN CHRISTOPHER (PT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:YOLITZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:SUITE 103 AND 308
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4548
Practice Address - Country:US
Practice Address - Phone:770-460-1900
Practice Address - Fax:770-719-1214
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00771195OtherRAILROAD MEDICARE
GA65BBCPHMedicare ID - Type Unspecified
GAS73576Medicare UPIN
GA202I658154Medicare PIN