Provider Demographics
NPI:1356661078
Name:WOLKEN, RYAN JOHN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOHN
Last Name:WOLKEN
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:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68045-0101
Mailing Address - Country:US
Mailing Address - Phone:402-685-4499
Mailing Address - Fax:402-685-4491
Practice Address - Street 1:312 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NE
Practice Address - Zip Code:68045-1196
Practice Address - Country:US
Practice Address - Phone:402-685-4499
Practice Address - Fax:402-685-4491
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025464600Medicaid