Individual
TED RYERSBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
42613 N 46TH DR, NEW RIVER, AZ 85087-5975
(623) 518-6886
Mailing address
42613 N 46TH DR, NEW RIVER, AZ 85087-5975
(623) 518-6886
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
638
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACCCHS
962523
AZ
Enumeration date
03/14/2007
Last updated
07/08/2007
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