Provider Demographics
NPI:1255666483
Name:HEUER, RYAN M (MS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:HEUER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7166
Mailing Address - Country:US
Mailing Address - Phone:309-779-2828
Mailing Address - Fax:309-779-2839
Practice Address - Street 1:4112 46TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7166
Practice Address - Country:US
Practice Address - Phone:309-779-2828
Practice Address - Fax:309-779-2839
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist