Active NPI
Ryan P Tully, D.P.T
- Physical Therapist
- Maplewood, MN
National Provider Identifier
1114200508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 1655 Beam Ave
Maplewood, MN 55109-1163 - Phone
- (231) 846-8766
- NPI assigned
- Sep 22, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
1655 Beam Ave
Maplewood, MN 55109-1163
Mailing address
500 Osborne Rd NE Ste 365
Fridley, MN 55432-2769
Phone (632) 362-1537
Other practice location 1
500 Osborne Rd NE Ste 365
Fridley, MN 55432-2769
Phone (763) 236-2153
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640131200000",
"number": "1114200508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 OSBORNE RD NE STE 365",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554322769",
"telephone_number": "632-362-1537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1655 BEAM AVE",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551091163",
"telephone_number": "231-846-8766"
}
],
"practiceLocations": [
{
"address_1": "500 Osborne Rd NE Ste 365",
"address_purpose": "LOCATION",
"city": "Fridley",
"state": "MN",
"postal_code": "554322769",
"country_code": "US",
"telephone_number": "763-236-2153",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TULLY",
"first_name": "RYAN",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "D.P.T",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-22",
"last_updated": "2021-12-22",
"certification_date": "2021-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
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- Jerry Tu, M.D.
- Kai Adam Tuominen, MD
- Twin Cities Children'S Anesthesia Dentistry, PLLC
- Twin Cities Children'S General Anesthesia Dentistry
- Twin Cities Children'S Surgery Center, LLC
- Twin Cities Oral & Maxillofacial Surgery, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.