Provider Demographics
NPI:1205514700
Name:SMITH, RYAN C (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16550 W 78TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-4316
Mailing Address - Country:US
Mailing Address - Phone:952-873-7400
Mailing Address - Fax:952-873-7408
Practice Address - Street 1:16550 W 78TH ST STE B
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-4316
Practice Address - Country:US
Practice Address - Phone:952-873-7400
Practice Address - Fax:952-873-7408
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist