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General NPI Number Information
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NPI Number | 1437174885
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Entity Type | Individual
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Provider Name | RYAN DEREK LAMPE PT/ATC
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 560 N 2ND ST
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City | BREESE
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State | IL
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Zip | 62230-1650
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Country | US
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Telephone | 618-526-7801
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Fax | 618-526-7901
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Provider Business Mailing Address
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Address Line | 15 APEX DR
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City | HIGHLAND
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State | IL
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Zip | 62249-1282
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Country | US
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Telephone | 618-651-0444
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Fax | 618-654-5439
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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 | 070014296
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License Number State | IL
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