Provider Demographics
NPI:1134417249
Name:WOOD, RYAN HADLEY (DPT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:HADLEY
Last Name:WOOD
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:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:101 NW 1ST ST
Practice Address - Street 2:114
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1259
Practice Address - Country:US
Practice Address - Phone:812-402-0444
Practice Address - Fax:812-402-0449
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011575A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05011575AOtherPHYSICAL THERAPY LICENSE
KY006466OtherPHYSICAL THERAPY LICENSE
ININ3183001Medicare PIN