Provider Demographics
NPI:1740728153
Name:WAACK, RYAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WAACK
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 1:1130 S. SCOTT BLVD.
Mailing Address - Street 2:STE. 1
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240
Mailing Address - Country:US
Mailing Address - Phone:319-354-2429
Mailing Address - Fax:319-338-5775
Practice Address - Street 1:100 ALEXANDER DR.
Practice Address - Street 2:STE. 4
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772
Practice Address - Country:US
Practice Address - Phone:563-886-3421
Practice Address - Fax:563-886-2083
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist