Provider Demographics
NPI:1306286984
Name:RYAN, DEBORAH K (RPT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:RYAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 RIVERSIDE DR
Mailing Address - Street 2:STE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204
Mailing Address - Country:US
Mailing Address - Phone:478-633-6633
Mailing Address - Fax:478-633-4295
Practice Address - Street 1:1014 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2025
Practice Address - Country:US
Practice Address - Phone:478-633-2742
Practice Address - Fax:478-633-6268
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist