Jaclyn Marie Ryan, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

10795 Issued in MN

Practice address

155 Radio Drive
Woodbury, MN 55125

Phone

(952) 831-8742

NPI assigned

Aug 23, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Berthiaume Former name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tria Orthopaedic Center LLC

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1518273085

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Tria Orthopaedic Center LLC

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1346624384

  Physical Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1073030995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 RADIO DRIVE",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "952-831-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-23",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "10795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "BERTHIAUME",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannon M Rust, PT
• Ruti Transports
• Alyssa Paige Rutten
• Ryan L. Isaacson, O.D., PLLC
• Ryan T Pfundheller DDS PLLC
• Katelyn Jane Rykhus
• Katriana L Ryther
• S & K Alternatives, LLC
• S & K Alternatives, LLC
• John Robert Sabino, LICSW

• Physical Therapist in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.