MEDICARE: DR. RYAN ANTHONY RYBA PT, 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	070.024571	IL
2	225100000X	Physical Therapist	070024571	IL

General Provider Information

NPI Number	:	1639725443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ANTHONY RYBA PT, DPT

Provider Business Mailing Address
First Line	:	7777 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-9490
Country	:	US
Telephone Number	:	815-806-8777
Fax Number	:	815-806-8777

Provider Business Practice Location Address
First Line	:	7777 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-9490
Country	:	US
Telephone Number	:	815-806-8777
Fax Number	:	815-806-9777

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

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	08/16/2019

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