Provider Demographics
NPI:1699792374
Name:RYAN RANCH PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:RYAN RANCH PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST,OWNER OF BUSINES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRIED
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:831-372-2963
Mailing Address - Street 1:550 CAMINO EL ESTERO
Mailing Address - Street 2:STE 100
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3231
Mailing Address - Country:US
Mailing Address - Phone:831-372-2963
Mailing Address - Fax:831-656-9179
Practice Address - Street 1:550 CAMINO EL ESTERO
Practice Address - Street 2:STE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3231
Practice Address - Country:US
Practice Address - Phone:831-372-2963
Practice Address - Fax:831-656-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083777627OtherTRICARE WPS PROVIDER NUMBER
CAZZZ09962ZOtherBLUE SHILED PIN
CAZZZ09962ZOtherBLUE SHILED PIN