MEDICARE: RYAN ROENIGK PT, ATC

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	2255A2300X	Athletic Trainer	AT7195	TX
2	225100000X	Physical Therapist	3130581	TX

General Provider Information

NPI Number	:	1942679071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN ROENIGK PT, ATC

Provider Business Mailing Address
First Line	:	5809 RAYBURN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3026
Country	:	US
Telephone Number	:	419-708-8256
Fax Number	:

Provider Business Practice Location Address
First Line	:	5809 RAYBURN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3026
Country	:	US
Telephone Number	:	419-708-8256
Fax Number	:

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

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	04/02/2026

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