Ryan Taylor Faircloth
Individual provider Active NPI Physical Therapy Assistant · Pelham, GA
NPI 1780143354 · NPPES record last updated Mar 13, 2019
Key facts
- NPI
- 1780143354
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA004184 (GA)
- Practice address
- 3139 US Highway 19 NE
Pelham, GA 31779-5391 - Phone
- (229) 319-5145
- NPI assigned
- Mar 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA004184 | GA | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA004184 | GA | Yes |
Addresses
Primary practice location
3139 US Highway 19 NE
Pelham, GA 31779-5391
Mailing address
3139 US Highway 19 NE
Pelham, GA 31779-5391
Phone (229) 319-5145
Other providers in Pelham, GA
- Anicklette O Crumbley
- David B Drury, MD
- Cynthia Parker Drury
- David Brian Drury
- Rebekah Sharon Elliott
- Traci Williams Franklin
- Georgia Pines Community Service Board
- Georgia Pines Community Service Board
- Georgia Pines Community Service Board
- Hospital Authority of Mitchell County
All providers in Pelham, GA · Physical Therapy Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.