Provider Demographics
NPI:1093329948
Name:RENKIEWICZ, RYAN PATRICK (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:RENKIEWICZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 S 4550 W
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-6771
Mailing Address - Country:US
Mailing Address - Phone:231-920-0924
Mailing Address - Fax:
Practice Address - Street 1:2150 W 4800 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1844
Practice Address - Country:US
Practice Address - Phone:801-476-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8081236-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer