Ryan Ebersole

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12605 Issued in MN

Practice address

907 Embarcadero Dr
El Dorado Hills, CA 95762-4087

Phone

(916) 933-1221

Fax

(916) 933-0871

NPI assigned

May 26, 2022

Last updated

Dec 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• El Dorado Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • El Dorado Hills, CA
  • NPI 1033446448

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1811635162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 EMBARCADERO DR",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 EMBARCADERO DR",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624087",
            "telephone_number": "916-933-1221",
            "fax_number": "916-933-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-26",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Duradent Dental Inc.
• Shelton Duruisseau, DR.
• Messiah Dyer
• Dana Earnest
• Devin Speer Eastman
• Kianna Leigh Edge
• Edwards Everhart Dental
• Michelle Ann Edwards, D.D.S.
• Nolan Eger
• El Dorado Family Dental

• Physical Therapist in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.