Active NPI
Tracey J Ryan, PT
- Physical Therapist
- Mystic, CT
National Provider Identifier
1790187136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003995
- Practice address
- 44 Maritime Drive
Mystic, CT 06355 - Phone
- (860) 572-1700
- Fax
- (860) 572-1700
- NPI assigned
- Sep 17, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 003995 | CT | Primary |
Addresses
Primary practice location
44 Maritime Drive
Mystic, CT 06355
Mailing address
44 Maritime Drive
Mystic, CT 06355
Phone (860) 572-1700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003995 | CT | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410912000000",
"number": "1790187136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 MARITIME DRIVE",
"city": "MYSTIC",
"state": "CT",
"postal_code": "06355",
"telephone_number": "860-572-1700",
"fax_number": "860-572-4270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 MARITIME DRIVE",
"city": "MYSTIC",
"state": "CT",
"postal_code": "06355",
"telephone_number": "860-572-1700",
"fax_number": "860-572-1700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "TRACEY",
"middle_name": "J",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-17",
"last_updated": "2014-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "003995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mystic, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.