Provider Demographics
NPI:1053575514
Name:SMITH, RYAN KAYE (PT, DPT, OCS)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:KAYE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 GALAXIE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8602
Mailing Address - Country:US
Mailing Address - Phone:651-241-3880
Mailing Address - Fax:651-241-3890
Practice Address - Street 1:14655 GALAXIE AVE STE 160
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8602
Practice Address - Country:US
Practice Address - Phone:651-241-3880
Practice Address - Fax:651-241-3890
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist