Provider Demographics
NPI:1356678841
Name:MCMAHON, RYAN CHARLES (MS, ATC, PES)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHARLES
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N ROME AVE APT 4406
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-0053
Mailing Address - Country:US
Mailing Address - Phone:609-575-2019
Mailing Address - Fax:
Practice Address - Street 1:4541 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1407
Practice Address - Country:US
Practice Address - Phone:813-684-2663
Practice Address - Fax:908-685-2413
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001255002255A2300X
FLAL47852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer