Provider Demographics
NPI:1134159031
Name:STUKEL, RYAN NICKOLE (PT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NICKOLE
Last Name:STUKEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 N MO PAC EXPY
Mailing Address - Street 2:SUITE 575B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2475
Mailing Address - Country:US
Mailing Address - Phone:512-821-1101
Mailing Address - Fax:512-821-1071
Practice Address - Street 1:12417 N MO PAC EXPY
Practice Address - Street 2:SUITE 575B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2475
Practice Address - Country:US
Practice Address - Phone:512-821-1101
Practice Address - Fax:512-821-1071
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7654Medicare PIN