Provider Demographics
NPI:1396458931
Name:O'BOYLE, RYAN P (PTA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:O'BOYLE
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 1:1240 ESSINGTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8409
Mailing Address - Country:US
Mailing Address - Phone:815-744-7018
Mailing Address - Fax:
Practice Address - Street 1:1240 ESSINGTON RD STE 100
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8409
Practice Address - Country:US
Practice Address - Phone:815-744-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009662225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant