Basic Information
Provider Information
NPI: 1922588037
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUSSELL
FirstName: RYAN
MiddleName: JOSEPH J.
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Mailing Information
Address1: 317 ETHERIDGE MILL RD
Address2:  
City: MILNER
State: GA
PostalCode: 302573782
CountryCode: US
TelephoneNumber: 6786039364
FaxNumber:  
Practice Location
Address1: 747 S 8TH ST STE D
Address2:  
City: GRIFFIN
State: GA
PostalCode: 302244884
CountryCode: US
TelephoneNumber: 7702296498
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2018
LastUpdateDate: 08/17/2018
NPIDeactivationReasonCode:  
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ProviderGenderCode: M
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IsSoleProprietor: N
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X013624GAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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