Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070-007745 | IL |
Y | 2251G0304X | Physical Therapist - Geriatrics | 070-007745 | IL |
N | 2251S0007X | Physical Therapist - Sports | 070-007745 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070-007745 | IL |
NPI | 1205051901 |
---|---|
Provider Name | Bryan D Ryndak |
First Address | Algonquin, IL 60102-6852 |
Second Address | Algonquin, IL 60102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 05/03/2019 |