Provider Demographics
NPI:1275846016
Name:DECKER, RYAN A (DPT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:A
Last Name:DECKER
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 1:2540 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9106
Mailing Address - Country:US
Mailing Address - Phone:616-772-2184
Mailing Address - Fax:
Practice Address - Street 1:10969 SE 175TH PL
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-0902
Practice Address - Country:US
Practice Address - Phone:352-347-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25486225100000X
MI5501014086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist