Provider Demographics
NPI:1649487604
Name:RYAN, NATHAN RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:RICHARD
Last Name:RYAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20528 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-1007
Mailing Address - Country:US
Mailing Address - Phone:507-382-3439
Mailing Address - Fax:
Practice Address - Street 1:1284 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1253
Practice Address - Country:US
Practice Address - Phone:651-686-0098
Practice Address - Fax:651-686-0499
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic