Provider Demographics
NPI:1720807928
Name:KELLEN RYAN SCANTLEBURY PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:KELLEN RYAN SCANTLEBURY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANTLEBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-875-8348
Mailing Address - Street 1:2103 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4521
Mailing Address - Country:US
Mailing Address - Phone:646-875-8348
Mailing Address - Fax:
Practice Address - Street 1:2103 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4521
Practice Address - Country:US
Practice Address - Phone:646-875-8348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy