Provider Demographics
NPI:1730745068
Name:RYAN, EMILY ANN (PTA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 RALPH RAHN RD
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-3105
Mailing Address - Country:US
Mailing Address - Phone:912-547-6246
Mailing Address - Fax:
Practice Address - Street 1:125 SOUTHERN JUNCTION BLVD BLDG 800
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2214
Practice Address - Country:US
Practice Address - Phone:912-348-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2945225200000X
GAPTA003027225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant