Healthcare Provider Details

I. General information

NPI: 1275363400
Provider Name (Legal Business Name): RYAN ENERSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 UNIVERSITY AVE STE 385
WEST DES MOINES IA
50266-8289
US

IV. Provider business mailing address

PO BOX 424
DES MOINES IA
50302-0424
US

V. Phone/Fax

Practice location:
  • Phone: 515-875-9706
  • Fax: 515-875-9707
Mailing address:
  • Phone: 515-875-9178
  • Fax: 515-875-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number126600
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: