Provider Demographics
NPI:1699864447
Name:KLUSMAN, RYAN ERIC (PT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ERIC
Last Name:KLUSMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 E 154TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2874
Mailing Address - Country:US
Mailing Address - Phone:913-634-0880
Mailing Address - Fax:913-897-9696
Practice Address - Street 1:15100 METCALF AVE STE 102
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2899
Practice Address - Country:US
Practice Address - Phone:913-897-1100
Practice Address - Fax:913-897-9696
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-3048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist