Ryan Daniel McCullough, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

4615 Issued in AR

Practice address

75 Industrial Drive
Ash Flat, AR 72513

Phone

(501) 352-6105

NPI assigned

Mar 16, 2021

Last updated

Mar 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1992380455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 EMERSON DR.",
            "city": "VIOLET HILL",
            "state": "AR",
            "postal_code": "72584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 INDUSTRIAL DRIVE",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "72513",
            "telephone_number": "501-352-6105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 Sanders St",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "AR",
            "postal_code": "725768002",
            "country_code": "US",
            "telephone_number": "501-352-6105",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCULLOUGH",
        "first_name": "RYAN",
        "middle_name": "DANIEL",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "4615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kindalh L Mayfield, MHPP
• McBryde Therapy Ops, Inc.
• Alicia Dawn McBryde, OTR
• Amanda McCullough
• Emily Elizabeth McCullough
• Karen McDonald, CDA
• Michelle M. McGowen, MHPP
• Leslie McKnatt, RECOVERY ASSISTANT
• Kendra Metcalf, LPC
• Robin Miller, RECOVERY ASSISTANT

• Physical Therapy Assistant in Ash Flat, AR
• Providers in Ash Flat, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.