Provider Demographics
NPI:1902456411
Name:KALLAS, RYKER GREGORY (DPT)
Entity type:Individual
Prefix:MR
First Name:RYKER
Middle Name:GREGORY
Last Name:KALLAS
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 1:1730 BOLLINGER RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7217
Mailing Address - Country:US
Mailing Address - Phone:203-733-6789
Mailing Address - Fax:
Practice Address - Street 1:60 OLD NEW MILFORD RD STE 2A
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2434
Practice Address - Country:US
Practice Address - Phone:203-775-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27612225100000X
CT12891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist