Basic Information
| Provider Information | |||||||||
| NPI: | 1588845333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RYAN CENTER FOR HAND THERAPY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S KENNEDY DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BRADLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609152682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159360400 | ||||||||
| FaxNumber: | 8159360416 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S KENNEDY DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BRADLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609152682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159360400 | ||||||||
| FaxNumber: | 8159360416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2007 | ||||||||
| LastUpdateDate: | 11/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | RYAN | ||||||||
| AuthorizedOfficialFirstName: | JOALICE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8159360400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MOTR/L, CHT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 056005395 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.