Healthcare Provider Details

I. General information

NPI: 1871696013
Provider Name (Legal Business Name): RYAN BEDINGFIELD MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19045 W CAPITOL DR SUITE 101
BROOKFIELD WI
53045-2706
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 262-790-9800
  • Fax: 262-790-9893
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10820-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: