Provider Demographics
NPI:1215657523
Name:SCHOTT, RYAN
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:SCHOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 POLO DR APT 513
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-4015
Mailing Address - Country:US
Mailing Address - Phone:540-645-7149
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR STE 1
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5302
Practice Address - Country:US
Practice Address - Phone:540-645-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist