Healthcare Provider Details

I. General information

NPI: 1053361030
Provider Name (Legal Business Name): RYAN THOMAS GIRRBACH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 SCARBOROUGH DR STE 200
COLORADO SPRINGS CO
80920-7513
US

IV. Provider business mailing address

8540 SCARBOROUGH DR STE 200
COLORADO SPRINGS CO
80920-7513
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-7500
  • Fax:
Mailing address:
  • Phone: 719-630-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT.0012732
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-3663
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501017657
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1213
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT60476692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: