Active NPI
Ryan Gaynor
- Physical Therapist
- Brookfield, WI
National Provider Identifier
1437179215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 19045 W Capitol Dr
Suite 101
Brookfield, WI 53045-2706 - Phone
- (262) 790-9800
- Fax
- (262) 790-9893
- NPI assigned
- Jul 21, 2006
- Last updated
- Apr 13, 2010
- 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 | NU | Primary |
Addresses
Primary practice location
19045 W Capitol Dr
Suite 101
Brookfield, WI 53045-2706
Mailing address
6908 N Santa Monica Blvd
Fox Point, WI 53217-3942
Phone (414) 352-2082
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40466100 | Medicaid | WI |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freedom Physical Therapy Services SC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Fox Point, WI
- NPI 1063406544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271116800000",
"number": "1437179215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6908 N SANTA MONICA BLVD",
"city": "FOX POINT",
"state": "WI",
"postal_code": "532173942",
"telephone_number": "414-352-2082",
"fax_number": "414-352-5279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19045 W CAPITOL DR",
"address_2": "SUITE 101",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530452706",
"telephone_number": "262-790-9800",
"fax_number": "262-790-9893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAYNOR",
"first_name": "RYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2010-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40466100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.