Provider Demographics
NPI:1134212228
Name:RYSER, MOLLY E (PT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:RYSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:E
Other - Last Name:PETRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 BUSCH PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4505
Mailing Address - Country:US
Mailing Address - Phone:847-378-4970
Mailing Address - Fax:
Practice Address - Street 1:2499 E JOLIET HWY
Practice Address - Street 2:UNIT 112
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2592
Practice Address - Country:US
Practice Address - Phone:815-462-9420
Practice Address - Fax:815-462-9421
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931618OtherMEDICARE RAILROAD
ILP00342562Medicare PIN
IL202845130Medicare PIN
ILK50779Medicare PIN
ILK33096Medicare PIN
IL209812009Medicare PIN
ILP00931618OtherMEDICARE RAILROAD