Provider Demographics
NPI:1164709226
Name:WEIBLE, RYAN CHRISTIAN (AT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTIAN
Last Name:WEIBLE
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854D STONE CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5061
Mailing Address - Country:US
Mailing Address - Phone:614-506-2743
Mailing Address - Fax:
Practice Address - Street 1:854D STONE CROSSING LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-5061
Practice Address - Country:US
Practice Address - Phone:614-506-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer