Healthcare Provider Details

I. General information

NPI: 1033703368
Provider Name (Legal Business Name): RYAN BLANEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N91W15750 FALLS PKWY
MENOMONEE FALLS WI
53051-2301
US

IV. Provider business mailing address

N91W15750 FALLS PKWY
MENOMONEE FALLS WI
53051-2301
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-1100
  • Fax: 262-532-1409
Mailing address:
  • Phone: 262-532-1447
  • Fax: 262-532-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number15273-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: