MEDICARE: RYAN THOMAS GUDENKAUF

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	1671594	ID

General Provider Information

NPI Number	:	1427906460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN THOMAS GUDENKAUF

Provider Business Mailing Address
First Line	:	912 S WASHINGTON AVE
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-3501
Country	:	US
Telephone Number	:	208-365-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 S WASHINGTON AVE
Second Line	:
City	:	EMMETT
State	:	ID
Zip	:	83617-3501
Country	:	US
Telephone Number	:	208-365-4400
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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