Provider Demographics
NPI:1932108537
Name:RESSLER, ROBERT RYAN (MPT, LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RYAN
Last Name:RESSLER
Suffix:
Gender:M
Credentials:MPT, LAT, ATC, CSCS
Other - Prefix:MR
Other - First Name:ROBBIE
Other - Middle Name:RYAN
Other - Last Name:RESSLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT, LAT, ATC, CSCS
Mailing Address - Street 1:1336 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4219
Mailing Address - Country:US
Mailing Address - Phone:936-559-7163
Mailing Address - Fax:936-569-7301
Practice Address - Street 1:1336 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4219
Practice Address - Country:US
Practice Address - Phone:936-559-7163
Practice Address - Fax:936-569-7301
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11466892251S0007X
TXAT31632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169929002Medicaid
TX8A5578Medicare PIN