Provider Demographics
NPI:1285085050
Name:RYAN, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:RYAN
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 1:2801 FOURTH STREET, SUITE 4
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343
Mailing Address - Country:US
Mailing Address - Phone:318-339-6401
Mailing Address - Fax:318-339-6403
Practice Address - Street 1:2801 FOURTH STREET, SUITE 4
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343
Practice Address - Country:US
Practice Address - Phone:318-339-6401
Practice Address - Fax:318-339-6403
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist