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Individual

MRS. CANDICE B RYAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
1202 MERRICK DR, ARDMORE, OK 73401-1824
(580) 226-6754
Mailing address
1202 MERRICK DRIVE, ARDMORE, OK 73401
(580) 226-6754
(580) 226-0394

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1400
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1400
LICENSE #
OK
Enumeration date
08/30/2006
Last updated
12/28/2007
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