MEDICARE: COLLEEN RYNN PT, DPT, SCS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT35450	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1730320458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN RYNN PT, DPT, SCS

Provider Business Mailing Address
First Line	:	1529 SEABRIGHT AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 BEARD CREEK RD
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6433
Country	:	US
Telephone Number	:	970-569-7770
Fax Number	:

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

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	02/04/2021

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