Provider Demographics
NPI:1093233066
Name:MAXFIELD, RYAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:MAXFIELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 N 2000 W STE 204
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9230
Mailing Address - Country:US
Mailing Address - Phone:801-731-5421
Mailing Address - Fax:801-732-0303
Practice Address - Street 1:2850 N 2000 W STE 204
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9230
Practice Address - Country:US
Practice Address - Phone:801-731-5421
Practice Address - Fax:801-732-0303
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10486902-2401225100000X
AZ13236PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist