Provider Demographics
NPI:1548043409
Name:JANG, RYAN HAEKWON (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:HAEKWON
Last Name:JANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 WHITE ASH PL
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4030
Mailing Address - Country:US
Mailing Address - Phone:240-778-3700
Mailing Address - Fax:
Practice Address - Street 1:7625 MAPLE LAWN BLVD STE 140
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2565
Practice Address - Country:US
Practice Address - Phone:301-497-3070
Practice Address - Fax:301-497-3071
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist