Basic Information
Provider Information
NPI: 1932713138
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RYKIEL
FirstName: HALEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 910 FREDERICK RD
Address2:  
City: CATONSVILLE
State: MD
PostalCode: 212284516
CountryCode: US
TelephoneNumber: 4106441880
FaxNumber: 4106440971
Practice Location
Address1: 910 FREDERICK RD
Address2:  
City: CATONSVILLE
State: MD
PostalCode: 212284516
CountryCode: US
TelephoneNumber: 4106441880
FaxNumber: 4106463623
Other Information
ProviderEnumerationDate: 09/04/2020
LastUpdateDate: 09/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X27982MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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