Healthcare Provider Details

I. General information

NPI: 1942268321
Provider Name (Legal Business Name): JAN MARIE RYGH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 TRANSFER RD SUITE 16
SAINT PAUL MN
55114-1427
US

IV. Provider business mailing address

505 LAKESIDE DR S
BAYPORT MN
55003-1306
US

V. Phone/Fax

Practice location:
  • Phone: 651-646-1625
  • Fax:
Mailing address:
  • Phone: 651-342-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2880
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: