Provider Demographics
NPI:1982785457
Name:HANIGAN, RYAN BENJAMIN (PT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:BENJAMIN
Last Name:HANIGAN
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:5399 S US HIGHWAY 41 STE 113
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4781
Practice Address - Country:US
Practice Address - Phone:812-298-8883
Practice Address - Fax:812-298-8889
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28551225100000X
IN05011579A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28551FMedicare ID - Type Unspecified