Provider Demographics
NPI:1053957845
Name:GRONEMAN, RYAN (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:GRONEMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RIDGECREST CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4974
Mailing Address - Country:US
Mailing Address - Phone:801-882-1590
Mailing Address - Fax:
Practice Address - Street 1:1400 E PUGH DR STE 28
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3938
Practice Address - Country:US
Practice Address - Phone:812-232-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013629A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist