Provider Demographics
NPI:1366910200
Name:BLAUER, RYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BLAUER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FOOTHILL LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4106
Mailing Address - Country:US
Mailing Address - Phone:631-418-4472
Mailing Address - Fax:
Practice Address - Street 1:770 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1956
Practice Address - Country:US
Practice Address - Phone:516-307-8067
Practice Address - Fax:516-307-8069
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist