Provider Demographics
NPI:1275597577
Name:NUTT, RYAN C (LAT, ATC, EMT-I)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:C
Last Name:NUTT
Suffix:
Gender:M
Credentials:LAT, ATC, EMT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21626 GANNET PEAK WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0137
Mailing Address - Country:US
Mailing Address - Phone:281-855-0655
Mailing Address - Fax:
Practice Address - Street 1:21626 GANNET PEAK WAY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-0137
Practice Address - Country:US
Practice Address - Phone:281-855-0655
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer