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General NPI Number Information
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NPI Number | 1164901138
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Entity Type | Individual
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Provider Name | RYAN NIED PT
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Gender | Male
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 471 S ARCH AVE
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1832
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Country | US
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Telephone | 715-246-3809
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Fax |
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Provider Business Mailing Address
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Address Line | 414 S DIVISION ST APT 8
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City | ROBERTS
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State | WI
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Zip | 54023-9610
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Country | US
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Telephone | 779-537-4175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14351-24
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License Number State | WI
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