Provider Demographics
NPI:1952057994
Name:FORTES, RYAN SAMONTE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SAMONTE
Last Name:FORTES
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 MARQUETTE RD APT C3
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1576
Mailing Address - Country:US
Mailing Address - Phone:917-861-3525
Mailing Address - Fax:
Practice Address - Street 1:578 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MARSEILLES
Practice Address - State:IL
Practice Address - Zip Code:61341-1814
Practice Address - Country:US
Practice Address - Phone:815-795-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist