Provider Demographics
NPI:1609877372
Name:FUHRIMAN, RYAN R (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:R
Last Name:FUHRIMAN
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S 900 E
Mailing Address - Street 2:#100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6657
Mailing Address - Country:US
Mailing Address - Phone:801-261-3321
Mailing Address - Fax:801-261-5942
Practice Address - Street 1:5151 S 900 E
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6601
Practice Address - Country:US
Practice Address - Phone:801-261-3321
Practice Address - Fax:801-261-5942
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT339376-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528901630009Medicaid
UTDB3830OtherRAILROAD MEDICARE
UT5417OtherDMBA
UT33937624000001OtherBLUE CROSS BLUE SHIELD
UT870388269BR1OtherEDUCATORS MUTUAL
UT83014OtherPEHP
UT870388269BR1OtherEDUCATORS MUTUAL