MEDICARE: RYAN LUKE STOLTZFUS 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NV484	OTHER	FL	FL MEDICARE

General Provider Information

NPI Number	:	1790163582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN LUKE STOLTZFUS DPT

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-5820
Fax Number	:	321-434-5821

Provider Business Practice Location Address
First Line	:	220 S COURTENAY PKWY STE B
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4893
Country	:	US
Telephone Number	:	321-434-5820
Fax Number	:	321-434-5821

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

Provider Enumeration Date	:	05/12/2015
Last Update Date	:	01/31/2025

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