Provider Demographics
NPI:1942679071
Name:ROENIGK, RYAN (PT, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ROENIGK
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 THISTLE PARK DR APT 5103
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1651
Mailing Address - Country:US
Mailing Address - Phone:419-708-8256
Mailing Address - Fax:
Practice Address - Street 1:5950 BRYANT IRVIN RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4215
Practice Address - Country:US
Practice Address - Phone:817-294-4646
Practice Address - Fax:833-311-0903
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT71952255A2300X
TX3130581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer