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General NPI Number Information
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NPI Number | 1649362732
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Entity Type | Individual
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Provider Name | RYAN P KLUCK DPT
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 123 HOSPITAL DR STE 1008
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City | WATERTOWN
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State | WI
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Zip | 53098-3320
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Country | US
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Telephone | 920-206-6500
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Fax | 920-261-4013
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Provider Business Mailing Address
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Address Line | 1115 EAGLE CT
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City | EDGERTON
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State | WI
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Zip | 53534-8548
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Country | US
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Telephone | 630-296-2223
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Fax | 630-759-3251
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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 | 12270-24
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070014460
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License Number State | IL
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