Provider Demographics
NPI:1710604087
Name:BLUMER, RYAN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:BLUMER
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 1:95 NE DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9673
Mailing Address - Country:US
Mailing Address - Phone:515-264-3405
Mailing Address - Fax:
Practice Address - Street 1:95 NE DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9673
Practice Address - Country:US
Practice Address - Phone:515-264-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0651638Medicaid