Provider Demographics
NPI:1326460056
Name:DEANE, RYAN (MS, ATC, CES)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DEANE
Suffix:
Gender:M
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 NORTHEAST AVE
Mailing Address - Street 2:APT. D201
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1405
Mailing Address - Country:US
Mailing Address - Phone:810-923-7515
Mailing Address - Fax:
Practice Address - Street 1:2213 SUMMIT STREET
Practice Address - Street 2:ATHLETIC TRAINING
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242
Practice Address - Country:US
Practice Address - Phone:330-672-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT10772255A2300X
OHAT.0046772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer