MEDICARE: RYAN W GIEBEL 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
1	225100000X	Physical Therapist	12841	NC
2	225100000X	Physical Therapist	070.019710	IL
3	225100000X	Physical Therapist	5501016953	MI

General Provider Information

NPI Number	:	1356645592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN W GIEBEL DPT

Provider Business Mailing Address
First Line	:	3240 W SILVER LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1374
Country	:	US
Telephone Number	:	810-714-4616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3240 W SILVER LAKE RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1374
Country	:	US
Telephone Number	:	810-714-4616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	07/14/2022

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