Provider Demographics
NPI:1689939068
Name:BURRAS, RYAN (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BURRAS
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 1:1220 JACOLYN DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1288
Mailing Address - Country:US
Mailing Address - Phone:319-396-0222
Mailing Address - Fax:319-396-1525
Practice Address - Street 1:1220 JACOLYN DR SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1288
Practice Address - Country:US
Practice Address - Phone:319-396-0222
Practice Address - Fax:319-396-1525
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1213029Medicare PIN
IAIB1213Medicare PIN
IAIB1212029Medicare PIN
IAIB1212Medicare PIN