Provider Demographics
NPI:1134298714
Name:CALHOON, RYAN (LMT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CALHOON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2872
Mailing Address - Country:US
Mailing Address - Phone:509-526-0655
Mailing Address - Fax:509-526-6944
Practice Address - Street 1:30 W MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2872
Practice Address - Country:US
Practice Address - Phone:509-526-0655
Practice Address - Fax:509-526-6944
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist