Provider Demographics
NPI:1770675415
Name:BORRI, RYAN R (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:R
Last Name:BORRI
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:27401 W IL ROUTE 22
Practice Address - Street 2:SUITE 107
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5999
Practice Address - Country:US
Practice Address - Phone:847-381-8812
Practice Address - Fax:847-381-6311
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070012618OtherIL PT LICENSE
ILL87102Medicare ID - Type UnspecifiedTHERAPIST NUMBER