Provider Demographics
NPI:1245858521
Name:THYSSEN, RYAN ROBERT (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ROBERT
Last Name:THYSSEN
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 1:7772 COUNTY ROAD M
Mailing Address - Street 2:
Mailing Address - City:LARSEN
Mailing Address - State:WI
Mailing Address - Zip Code:54947-9645
Mailing Address - Country:US
Mailing Address - Phone:920-574-5469
Mailing Address - Fax:
Practice Address - Street 1:200 S 9TH ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1393
Practice Address - Country:US
Practice Address - Phone:920-338-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15061-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist