Provider Demographics
NPI:1578664165
Name:TEBEEST, RYAN M (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:TEBEEST
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 1:1806 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-250-1485
Mailing Address - Fax:608-250-1456
Practice Address - Street 1:1806 W BELTLINE HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2334
Practice Address - Country:US
Practice Address - Phone:608-250-1485
Practice Address - Fax:608-250-1456
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10781-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36132000Medicaid
WI60797OtherDEAN HEALTH INSURANCE