Provider Demographics
NPI:1982796421
Name:RYBACKI, AMIE R (MPT)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:R
Last Name:RYBACKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:WI
Mailing Address - Zip Code:54025-0261
Mailing Address - Country:US
Mailing Address - Phone:715-245-5898
Mailing Address - Fax:715-245-5898
Practice Address - Street 1:242 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:WI
Practice Address - Zip Code:54025-2300
Practice Address - Country:US
Practice Address - Phone:715-245-5898
Practice Address - Fax:715-245-5898
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41810700Medicaid
MN6404866OtherMEDICA
MN288K7RYOtherBCBS
MNHP49268OtherHEALTH PARTNERS
WI41810700Medicaid