Provider Demographics
NPI:1396941076
Name:WILLIAMS, RYAN J (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials: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 1126
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-1126
Mailing Address - Country:US
Mailing Address - Phone:307-864-3877
Mailing Address - Fax:307-864-3549
Practice Address - Street 1:800 SHOSHONI ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-3216
Practice Address - Country:US
Practice Address - Phone:307-864-3877
Practice Address - Fax:307-864-3549
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313696OtherBLUE CROSS BLUE SHIELD
WYW20558Medicare ID - Type UnspecifiedMEDICARE PART B