Provider Demographics
NPI:1659968022
Name:KIMBALL, RYAN ROBERT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ROBERT
Last Name:KIMBALL
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 1:106 CALEY RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4178
Mailing Address - Country:US
Mailing Address - Phone:315-767-3110
Mailing Address - Fax:
Practice Address - Street 1:3475 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0005
Practice Address - Country:US
Practice Address - Phone:919-681-1656
Practice Address - Fax:919-668-1451
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist