Provider Demographics
NPI:1770297731
Name:GUILDNER, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GUILDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56048-9353
Mailing Address - Country:US
Mailing Address - Phone:507-210-0115
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5503
Practice Address - Country:US
Practice Address - Phone:507-977-2218
Practice Address - Fax:507-977-2180
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2448225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant