Provider Demographics
NPI:1164559316
Name:RYAN, JOHN PATRICK (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:RYAN
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 1:885 BROADWAY
Mailing Address - Street 2:BANGOR HIGH SCHOOL
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-992-5574
Mailing Address - Fax:207-941-6212
Practice Address - Street 1:885 BROADWAY
Practice Address - Street 2:BANGOR HIGH SCHOOL
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2916
Practice Address - Country:US
Practice Address - Phone:207-992-5574
Practice Address - Fax:207-941-6212
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer