Individual provider Active NPI

Ryan R Pretz, PT

  • Physical Therapist
  • Poplar Bluff, MO
National Provider Identifier
1962465658
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2004007960 Issued in MO
Practice address
3999 Highway PP Ste 2
Poplar Bluff, MO 63901-9130
Phone
(573) 712-2280
NPI assigned
Apr 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2004007960 MO Primary

Addresses

Primary practice location

3999 Highway PP Ste 2
Poplar Bluff, MO 63901-9130

Mailing address

PO Box 411277
Creve Coeur, MO 63141
Phone (573) 712-2280

Other practice location 1

2981 Kanell Blvd
Poplar Bluff, MO 63901
Phone (573) 712-2280

Other identifiers 2

IdentifierTypeStateIssuer
489274001MedicaidMO
P00607881OtherMOPALMETTO GBA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ryanpretz@mhccaremail.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040823000007 MO Practitioner - Physical Therapist in Private Practice 4880668243 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Rehabilitation, LLC Physical Therapist CurrentSince Mar 1, 2008 Accepting new patients
Select Physical Therapy Holdings, Inc. CurrentSince Sep 4, 2022 Accepting new patients
Prorehab PC Physical Therapist Past Accepting new patients
Ozark Physical Therapy, LLP Past Accepting new patients

Locations

2981 Kanell Blvd
Poplar Bluff, MO 63901
Phone (573) 712-2280

3999 Highway PP
Ste 2
Poplar Bluff, MO 63901
Phone (573) 712-2280

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1962465658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411277",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "573-712-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 HIGHWAY PP STE 2",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639019130",
            "telephone_number": "573-712-2280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2981 Kanell Blvd",
            "address_purpose": "LOCATION",
            "city": "Poplar Bluff",
            "state": "MO",
            "postal_code": "63901",
            "country_code": "US",
            "telephone_number": "573-712-2280",
            "fax_number": "573-778-9589",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRETZ",
        "first_name": "RYAN",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2004007960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "489274001",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "P00607881",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ryanpretz@mhccaremail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3999 Highway Pp Ste 2",
            "city": "Poplar Bluff",
            "state": "MO",
            "country_code": "US",
            "postal_code": "639019130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.