Provider Demographics
NPI:1013992999
Name:PALKONER, RYAN D (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:D
Last Name:PALKONER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:9250 E COSTILLA AVE STE 201
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80112-3662
Practice Address - Country:US
Practice Address - Phone:720-572-4873
Practice Address - Fax:720-572-4821
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0007323225100000X
CAPT28333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicare PIN
CAWPT28333AMedicare PIN