Healthcare Provider Details

I. General information

NPI: 1255949657
Provider Name (Legal Business Name): RYAN PIERCE TEMPLET PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3623 CROSSINGS DR STE 282
PRESCOTT AZ
86305-7101
US

IV. Provider business mailing address

2219 E 11TH ST UNIT 319
TULSA OK
74104-3645
US

V. Phone/Fax

Practice location:
  • Phone: 928-296-9285
  • Fax: 928-441-8421
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0016972
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number151773
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP027231T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: