Provider Demographics
NPI:1104476860
Name:MERRIHUE, RYAN JAMES (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:MERRIHUE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4900
Mailing Address - Country:US
Mailing Address - Phone:631-543-0004
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4900
Practice Address - Country:US
Practice Address - Phone:631-543-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY044896OtherOFFICE OF THE PROFESSIONS