Provider Demographics
NPI:1023290871
Name:ALBERT, RYAN C (PT,DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:ALBERT
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:4334 FOX VALLEY CENTER DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7945
Practice Address - Country:US
Practice Address - Phone:630-236-7544
Practice Address - Fax:630-236-7574
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931565OtherMEDICARE RAILROAD
IL216859106Medicare PIN
IL211082011Medicare PIN
IL212623007Medicare PIN
IL205782005Medicare PIN
ILIL2993003Medicare PIN
IL209812004Medicare PIN
IL216860014Medicare PIN
IL206974007Medicare PIN
IL209796008Medicare PIN
IL212608007Medicare PIN
IL214692014Medicare PIN
IL202845045Medicare PIN
IL212989009Medicare PIN
IL214708010Medicare PIN
IL216859018Medicare PIN
ILP00931565OtherMEDICARE RAILROAD
IL211585015Medicare PIN
ILK47339Medicare PIN