Provider Demographics
NPI:1336920180
Name:WILZOCH, RYAN J (PTA)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:WILZOCH
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 1:477 E MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1520
Mailing Address - Country:US
Mailing Address - Phone:330-375-7357
Mailing Address - Fax:
Practice Address - Street 1:477 E MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1520
Practice Address - Country:US
Practice Address - Phone:330-375-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013554225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant