Provider Demographics
NPI:1336507789
Name:RYAN MONACO PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:RYAN MONACO PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MIKEL DEBIASE
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:315-292-4032
Mailing Address - Street 1:31 SHERRILL LN
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2834
Mailing Address - Country:US
Mailing Address - Phone:315-732-0949
Mailing Address - Fax:315-732-0960
Practice Address - Street 1:2413 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-7717
Practice Address - Country:US
Practice Address - Phone:315-732-0949
Practice Address - Fax:315-732-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34595261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy