Healthcare Provider Details

I. General information

NPI: 1861372211
Provider Name (Legal Business Name): COLTON THOMAS RYDLEWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 MORTHLAND DR STE D
VALPARAISO IN
46385-4638
US

IV. Provider business mailing address

1841 E SUMMIT ST
CROWN POINT IN
46307-2768
US

V. Phone/Fax

Practice location:
  • Phone: 219-801-7777
  • Fax: 219-801-7677
Mailing address:
  • Phone: 219-801-7777
  • Fax: 219-801-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016149A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: