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NPI Code Detail

MEDICARE: RYAN RICHARD LORENZ DPT

MEDICARE: RYAN RICHARD LORENZ DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1566ND

General Provider Information

NPI Number : 1063731180
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN RICHARD LORENZ DPT
Provider Business Mailing Address
First Line : 11 N MAIN ST
Second Line : PO BOX 586
City : GWINNER
State : ND
Zip : 58040-4001
Country : US
Telephone Number : 701-678-2244
Fax Number : 701-678-2210
Provider Business Practice Location Address
First Line : 11 N MAIN ST
Second Line :
City : GWINNER
State : ND
Zip : 58040-0586
Country : US
Telephone Number : 701-678-2244
Fax Number : 701-678-2210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2010
Last Update Date : 05/28/2010

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