Individual
RYAN PATRICK MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., D.P.T.
Contact information
Practice address
1945 HILAND AVE, BURLEY, ID 83318-2714
(208) 647-0024
(208) 647-0239
Mailing address
1411 FALLS AVE E STE 401, TWIN FALLS, ID 83301-3455
(208) 969-9945
(208) 944-0488
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1204093
TX
225100000X
Physical Therapist
Primary
7649
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165348701
—
TX
05
—
PT25574
—
FL
Enumeration date
06/21/2010
Last updated
09/15/2021
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