Provider Demographics
NPI:1386101145
Name:RYAN, AUSTIN KENDALL (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:KENDALL
Last Name:RYAN
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 PALM HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1424
Mailing Address - Country:US
Mailing Address - Phone:727-781-3550
Mailing Address - Fax:727-781-3450
Practice Address - Street 1:4705 PALM HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1424
Practice Address - Country:US
Practice Address - Phone:727-781-3550
Practice Address - Fax:727-781-3450
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT34373OtherPT LICENSE