Provider Demographics
NPI:1932691409
Name:TOLLIS, RYAN G (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:G
Last Name:TOLLIS
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 1:15909 JACKSON CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8693
Mailing Address - Country:US
Mailing Address - Phone:719-481-0899
Mailing Address - Fax:719-481-0897
Practice Address - Street 1:15909 JACKSON CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-481-0899
Practice Address - Fax:719-481-0897
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist