Provider Demographics
NPI:1245015585
Name:TAKESHITA, RYAN M (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:TAKESHITA
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 1:11 GARDNER PARK DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9229
Mailing Address - Country:US
Mailing Address - Phone:406-589-6083
Mailing Address - Fax:406-219-0403
Practice Address - Street 1:777 E MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3809
Practice Address - Country:US
Practice Address - Phone:406-589-6083
Practice Address - Fax:406-219-0403
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT27185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist