MEDICARE: KIMBERLY ANN RYBAK

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	347C00000X	Private Vehicle
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1710698345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN RYBAK

Provider Business Mailing Address
First Line	:	1100 HAMILTON DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4228
Country	:	US
Telephone Number	:	440-376-2516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 HAMILTON DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-4228
Country	:	US
Telephone Number	:	440-376-2516
Fax Number	:

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

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/21/2022

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Directions to “ KIMBERLY ANN RYBAK ” Practice Location

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