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NPI Code Detail

MEDICARE: RYAN SOTIROFF PT,DPT

MEDICARE: RYAN SOTIROFF PT,DPT
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
1225100000XPhysical Therapist070019168IL

General Provider Information

NPI Number : 1356604029
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN SOTIROFF PT,DPT
Provider Business Mailing Address
First Line : 205 W WACKER DR
Second Line : SUITE 1020
City : CHICAGO
State : IL
Zip : 60606-1216
Country : US
Telephone Number : 312-640-0329
Fax Number : 312-640-0407
Provider Business Practice Location Address
First Line : 1728 N RICHMOND RD
Second Line :
City : MCHENRY
State : IL
Zip : 60051-5414
Country : US
Telephone Number : 815-578-8905
Fax Number : 815-578-8904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 07/30/2012

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