Individual
RYAN BOECKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1929 CEDARWOOD TRL, BELLEVILLE, IL 62226-7848
(618) 234-4619
Mailing address
630 S 6TH ST, BREESE, IL 62230-2041
(618) 830-3890
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
01/16/2020
Last updated
01/16/2020
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