Provider Demographics
NPI:1144764788
Name:KESTERHOLT, RYAN (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KESTERHOLT
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 1:4115 WILLIAM PENN HWY
Mailing Address - Street 2:ONE FRANKLIN CENTRE,
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4115 WILLIAM PENN HWY
Practice Address - Street 2:ONE FRANKLIN CENTRE
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668
Practice Address - Country:US
Practice Address - Phone:724-327-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer