Individual
AUDREY RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
(203) 679-6273
Mailing address
22 MASONIC AVE, WALLINGFORD, CT 06492-3048
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10225
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10225
CT PRACTICE LICENSE
CT
Enumeration date
06/18/2015
Last updated
05/21/2020
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