Provider Demographics
NPI:1235107806
Name:ROSSWURM, RYAN ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ANDREW
Last Name:ROSSWURM
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 1:1712 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2026
Mailing Address - Country:US
Mailing Address - Phone:513-290-1228
Mailing Address - Fax:
Practice Address - Street 1:4358 FERGUSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1680
Practice Address - Country:US
Practice Address - Phone:513-943-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10278225100000X
KYPT-005281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00743556OtherMEDICARE RAILROAD
KY0389233Medicare PIN