Provider Demographics
NPI:1245941061
Name:BOILEK, RYAN J (PTA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:BOILEK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1012
Mailing Address - Country:US
Mailing Address - Phone:708-989-5981
Mailing Address - Fax:
Practice Address - Street 1:RESTORE THERAPY SERVICES
Practice Address - Street 2:6100 MILLER AVE.
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403
Practice Address - Country:US
Practice Address - Phone:219-427-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005288A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant