Provider Demographics
NPI:1285712620
Name:FLEMING, RYAN JAMES (MPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAMES
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S SALISBURY BLVD
Mailing Address - Street 2:STE 1B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5453
Mailing Address - Country:US
Mailing Address - Phone:410-677-0700
Mailing Address - Fax:410-677-0883
Practice Address - Street 1:659 S SALISBURY BLVD
Practice Address - Street 2:STE 1B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5453
Practice Address - Country:US
Practice Address - Phone:410-677-0700
Practice Address - Fax:410-677-0883
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002201225100000X
MD21359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE022744P16Medicare PIN
DEG00716Medicare PIN