Provider Demographics
NPI:1366726846
Name:MYERS, RYAN BRUCE (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:BRUCE
Last Name:MYERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2924
Mailing Address - Country:US
Mailing Address - Phone:508-603-9525
Mailing Address - Fax:508-452-0095
Practice Address - Street 1:75 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2924
Practice Address - Country:US
Practice Address - Phone:508-603-9525
Practice Address - Fax:508-452-0095
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19626225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1222471OtherASH/CIGNA
MA110094254AMedicaid
MA9560858OtherAETNA
MA110094254AMedicaid