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NPI Code Detail

MEDICARE: MATTHEW RYAN

MEDICARE: MATTHEW RYAN
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 Therapist070.028056IL
2225100000XPhysical Therapist14770TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070.028056OTHERILSTATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION

General Provider Information

NPI Number : 1619674611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW RYAN
Provider Business Mailing Address
First Line : 2316 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7760
Country : US
Telephone Number : 312-739-3030
Fax Number :
Provider Business Practice Location Address
First Line : 2316 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7760
Country : US
Telephone Number : 312-739-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2023
Last Update Date : 01/13/2026

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