Provider Demographics
NPI:1871696013
Name:BEDINGFIELD, RYAN (MPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BEDINGFIELD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:19045 W CAPITOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2706
Practice Address - Country:US
Practice Address - Phone:262-790-9800
Practice Address - Fax:262-790-9893
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10820-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871696013Medicaid
WI001586454Medicare PIN
WI002132455Medicare PIN
WI000681341Medicare PIN
WI001485185Medicare PIN