Provider Demographics
NPI:1104990738
Name:SWENSON, RYAN KN (MSPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:KN
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1086
Mailing Address - Country:US
Mailing Address - Phone:605-582-8718
Mailing Address - Fax:
Practice Address - Street 1:1721 S CLEVELAND AVE
Practice Address - Street 2:200
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-5501
Practice Address - Country:US
Practice Address - Phone:605-334-8616
Practice Address - Fax:605-339-6982
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist