Provider Demographics
NPI:1003936139
Name:POMMIER, RYAN (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:POMMIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3052 WEBER DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502
Mailing Address - Country:US
Mailing Address - Phone:630-898-9700
Mailing Address - Fax:
Practice Address - Street 1:3052 WEBER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-5553
Practice Address - Country:US
Practice Address - Phone:630-898-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist