Provider Demographics
NPI:1144235904
Name:LAGODINSKI, RYAN (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LAGODINSKI
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-0368
Mailing Address - Country:US
Mailing Address - Phone:701-742-3267
Mailing Address - Fax:701-742-3201
Practice Address - Street 1:420 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2024
Practice Address - Country:US
Practice Address - Phone:701-742-3267
Practice Address - Fax:701-742-3201
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27204OtherBLUE SHIELD
ND27206OtherBLUE SHIELD
ND27201OtherBLUE SHIELD
ND27203OtherBLUE SHIELD
NDP00341184OtherRAILROAD MEDICARE
ND27205OtherBLUE SHIELD
ND51390Medicaid
NDCG3429OtherRAILROAD MEDICARE
ND27202OtherBLUE SHIELD
ND27207OtherBLUE SHIELD
NDP00341184Medicare PIN
ND27207OtherBLUE SHIELD
NDCG3429OtherRAILROAD MEDICARE
NDCG3429Medicare PIN