Individual
RYAN LOUIS MCDIVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
10940 E US HIGHWAY 36, AVON, IN 46123-7980
(317) 808-7000
(317) 808-7001
Mailing address
205 W WACKER DR, SUITE 1020, CHICAGO, IL 60606-1216
(312) 640-0329
(312) 640-0407
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009023A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201002710
—
IN
Enumeration date
07/10/2007
Last updated
05/17/2012
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