MEDICARE: RYAN JOHN PURFEERST MPT

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	9703-10	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497011688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JOHN PURFEERST MPT

Provider Business Mailing Address
First Line	:	1663 E DIVISION ST
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-1571
Country	:	US
Telephone Number	:	715-426-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 S 2ND ST STE 10
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-2403
Country	:	US
Telephone Number	:	715-426-7878
Fax Number	:	715-426-7852

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

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	06/29/2022

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