Provider Demographics
NPI:1710934898
Name:BAGLEY, RYAN KENNETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KENNETH
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:3021 FALLING WATERS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6793
Practice Address - Country:US
Practice Address - Phone:630-674-3210
Practice Address - Fax:630-674-3210
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL070014971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist