Provider Demographics
NPI:1538536859
Name:DORMO, MICHAEL RYAN (PT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RYAN
Last Name:DORMO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3939 RUFFIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1804
Mailing Address - Country:US
Mailing Address - Phone:858-380-4185
Mailing Address - Fax:858-609-6651
Practice Address - Street 1:3939 RUFFIN RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1804
Practice Address - Country:US
Practice Address - Phone:858-380-4185
Practice Address - Fax:858-609-6651
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA21978225100000X
CA298536225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist