Provider Demographics
NPI:1215375092
Name:DOMEYER, RYAN J (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:DOMEYER
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:312-640-0407
Practice Address - Street 1:3160 8TH ST SW
Practice Address - Street 2:SUITE 1
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1023
Practice Address - Country:US
Practice Address - Phone:515-967-4580
Practice Address - Fax:515-967-4899
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA005194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist