Provider Demographics
NPI:1891513818
Name:KOELLING, RYAN FREDRIC (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:FREDRIC
Last Name:KOELLING
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 1:58 RED OAK CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6811
Mailing Address - Country:US
Mailing Address - Phone:925-918-0090
Mailing Address - Fax:
Practice Address - Street 1:58 RED OAK CT
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6811
Practice Address - Country:US
Practice Address - Phone:925-918-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist