Provider Demographics
NPI:1881781151
Name:SCHAUL, RYAN J (MPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:J
Last Name:SCHAUL
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 1:3921 30TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1939
Mailing Address - Country:US
Mailing Address - Phone:262-925-5000
Mailing Address - Fax:
Practice Address - Street 1:10222 74TH ST STE 211
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-6810
Practice Address - Country:US
Practice Address - Phone:262-925-5020
Practice Address - Fax:262-925-5021
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013211225100000X
WI14959-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205782014Medicare PIN
ILK48126Medicare PIN
IL216860013Medicare PIN
ILP00220492Medicare PIN
IL202845002Medicare PIN
ILK17989Medicare PIN