Provider Demographics
NPI:1225147846
Name:HARTLEY, RYAN A (PT DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 LAKEVIEW PARKWAY SUITE 195
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-247-7200
Mailing Address - Fax:847-247-4340
Practice Address - Street 1:935 LAKEVIEW PARKWAY SUITE 195
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:847-247-7200
Practice Address - Fax:847-247-4340
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0034942392OtherBCBS
ILK26512Medicare ID - Type Unspecified
0034942392OtherBCBS