Provider Demographics
NPI:1275954489
Name:SANDERS, RYAN JAMES (MSAT, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MSAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MOSSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-1455
Mailing Address - Country:US
Mailing Address - Phone:864-704-6807
Mailing Address - Fax:
Practice Address - Street 1:100 MOSSPOINT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-1455
Practice Address - Country:US
Practice Address - Phone:864-704-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer