Individual
RYAN BOUSLOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(612) 725-2000
Mailing address
3648 45TH AVE S, MINNEAPOLIS, MN 55406-2929
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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