Provider Demographics
NPI:1558542225
Name:HRUSKA, RYAN JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:HRUSKA
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 1:1910 SOUTH 72ND STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1734
Mailing Address - Country:US
Mailing Address - Phone:402-391-2635
Mailing Address - Fax:402-391-0326
Practice Address - Street 1:1910 SOUTH 72ND STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1734
Practice Address - Country:US
Practice Address - Phone:402-391-2635
Practice Address - Fax:402-391-0326
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02466OtherBCBS
NE10024983700Medicaid
NE099186005Medicare PIN