Provider Demographics
NPI:1962713925
Name:CARLISLE, RYAN R (DPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:R
Last Name:CARLISLE
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 1:109 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2237
Mailing Address - Country:US
Mailing Address - Phone:814-734-1601
Mailing Address - Fax:814-734-1724
Practice Address - Street 1:109 WALKER DR
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2237
Practice Address - Country:US
Practice Address - Phone:814-734-1601
Practice Address - Fax:814-734-1724
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 020591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025290900001Medicaid