Provider Demographics
NPI:1356661078
Name:WOLKEN, RYAN JOHN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:WOLKEN
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 1:2108 TAYLOR AVE
Mailing Address - Street 2:STE 1100
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4642
Mailing Address - Country:US
Mailing Address - Phone:402-371-7545
Mailing Address - Fax:
Practice Address - Street 1:2108 TAYLOR AVE
Practice Address - Street 2:STE 1100
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4642
Practice Address - Country:US
Practice Address - Phone:402-371-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025464600Medicaid