Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 15273-24 | WI |
NPI | 1033703368 |
---|---|
Provider Name | Ryan Blaney |
First Address | Franklin, WI 53132-7712 |
Second Address | Franklin, WI 53132-7712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 26/04/2021 |