Provider Demographics
NPI:1922067974
Name:BEAN, RYAN (PT, DPT, OMPT, OCS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BEAN
Suffix:
Gender:M
Credentials:PT, DPT, OMPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:10078 LAPEER RD
Practice Address - Street 2:STE. B
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9031
Practice Address - Country:US
Practice Address - Phone:810-653-6200
Practice Address - Fax:810-653-6226
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist