MEDICARE: MOLLY E RYSER 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	070014152	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00931618	OTHER	IL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1134212228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY E RYSER PT

Provider Business Mailing Address
First Line	:	1300 BUSCH PKWY
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-4505
Country	:	US
Telephone Number	:	847-378-4970
Fax Number	:

Provider Business Practice Location Address
First Line	:	2499 E JOLIET HWY
Second Line	:	UNIT 112
City	:	NEW LENOX
State	:	IL
Zip	:	60451-2592
Country	:	US
Telephone Number	:	815-462-9420
Fax Number	:	815-462-9421

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	08/26/2021

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Directions to “ MOLLY E RYSER PT” Practice Location

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