Provider Demographics
NPI:1265830897
Name:GOUGHNOUR, RYAN THOMAS (ATC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:THOMAS
Last Name:GOUGHNOUR
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 1:287 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1226
Mailing Address - Country:US
Mailing Address - Phone:330-606-8720
Mailing Address - Fax:
Practice Address - Street 1:287 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1226
Practice Address - Country:US
Practice Address - Phone:330-606-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0042532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer