Provider Demographics
NPI:1063769669
Name:GARRISON, JOSEPH RYAN (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2163
Mailing Address - Country:US
Mailing Address - Phone:563-652-2474
Mailing Address - Fax:563-652-4096
Practice Address - Street 1:700 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2163
Practice Address - Country:US
Practice Address - Phone:563-652-2474
Practice Address - Fax:563-652-4096
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004619208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004619OtherSTATE LICENSE