MEDICARE: RYAN FLIPSE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05007929A	IN
2	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1114957933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN FLIPSE PT

Provider Business Mailing Address
First Line	:	10388 REDWOOD DRIVE
Second Line	:
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9502
Country	:	US
Telephone Number	:	219-365-0742
Fax Number	:

Provider Business Practice Location Address
First Line	:	12937 WICKER AVE
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9343
Country	:	US
Telephone Number	:	219-979-2734
Fax Number	:	219-924-4978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	10/22/2007

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Directions to “ RYAN FLIPSE PT” Practice Location

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