Provider Demographics
NPI:1609835032
Name:BALDRY, RYAN MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:BALDRY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2331
Mailing Address - Country:US
Mailing Address - Phone:920-222-1807
Mailing Address - Fax:
Practice Address - Street 1:1325 S ROCKWELL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2263
Practice Address - Country:US
Practice Address - Phone:920-222-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9982024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40437300Medicaid