Provider Demographics
NPI:1417593880
Name:SOWKA, RYAN PAUL
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:PAUL
Last Name:SOWKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 LEWIS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1968
Mailing Address - Country:US
Mailing Address - Phone:262-725-2737
Mailing Address - Fax:
Practice Address - Street 1:125 E STATE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1915
Practice Address - Country:US
Practice Address - Phone:262-903-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer