1215241591 NPI number — MR. RYAN C BOZANT PT

Table of content: MR. RYAN C BOZANT PT (NPI 1215241591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215241591 NPI number — MR. RYAN C BOZANT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOZANT
Provider First Name:
RYAN
Provider Middle Name:
C
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215241591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 CHURCH ST
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-654-8208
Provider Business Mailing Address Fax Number:
225-654-4642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
ZACHARY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70791-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-654-8208
Provider Business Practice Location Address Fax Number:
225-654-4642
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  07853 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07853 . This is a "LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com