Basic Information
| Provider Information | |||||||||
| NPI: | 1407575244 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUTTON | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | FRANK | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9218 KIMMER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801246733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037927377 | ||||||||
| FaxNumber: | 3039488667 | ||||||||
| Practice Location | |||||||||
| Address1: | 9218 KIMMER DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801246733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037927377 | ||||||||
| FaxNumber: | 3039488667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18632 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.