Provider Demographics
NPI:1407984263
Name:RYAN, MELISSA M (ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 NW 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4933
Mailing Address - Country:US
Mailing Address - Phone:360-620-2330
Mailing Address - Fax:
Practice Address - Street 1:1660 NW GILMAN BLVD
Practice Address - Street 2:STE 5
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5340
Practice Address - Country:US
Practice Address - Phone:360-620-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer