Provider Demographics
NPI:1104213784
Name:LEIBREICH, RYAN (MS, ATC,CSCS, USAW-1)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LEIBREICH
Suffix:
Gender:M
Credentials:MS, ATC,CSCS, USAW-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 HANOVER MNR
Mailing Address - Street 2:APARTMENT F- 108
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 HANOVER MNR
Practice Address - Street 2:APARTMENT F- 108
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2035
Practice Address - Country:US
Practice Address - Phone:937-403-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0051162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer