Provider Demographics
NPI:1417004417
Name:BRANDT, RYAN (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BRANDT
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 1:1311 WAKARUSA DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4798
Mailing Address - Country:US
Mailing Address - Phone:785-749-1300
Mailing Address - Fax:785-749-4746
Practice Address - Street 1:1311 WAKARUSA DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4798
Practice Address - Country:US
Practice Address - Phone:785-749-1300
Practice Address - Fax:785-749-4746
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS176538Medicare ID - Type UnspecifiedMEDICARE