Individual ProviderBruce A RyanPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1501 N Navarro, # C, Victoria, TX 77901-6027(361) 572-9113PECOS EnrollmentBased on the most recent information from CMS, provider Bruce A Ryan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1689605172Provider TypeIndividualFull NameRyan, Bruce ATitleMr.CredentialPHYSICAL THERAPISTGenderMaleSole ProprietorYesEnumeration Date7/5/2006Last Updated8/11/2011Contact InformationPractice LocationPractice Address1501 N Navarro, # C, Victoria, TX 77901-6027Phone(361) 572-9113Fax(361) 572-9195Mailing LocationMailing Address1501 N Navarro, # C, Victoria, TX 77901-6027Phone(361) 572-9113Fax(361) 572-9195Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1039311TexasProvider IdentifiersIDDescriptionIssuerID087704501DescriptionMedicaidIssuerUnlistedTexasID0877045-01DescriptionMedicaidIssuerUnlistedTexas