Provider Demographics
NPI:1417408188
Name:COONEY, RYAN (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:COONEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S CLEVELAND ST APT E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4076
Mailing Address - Country:US
Mailing Address - Phone:760-717-5405
Mailing Address - Fax:
Practice Address - Street 1:1 PIRATES COVE WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3066
Practice Address - Country:US
Practice Address - Phone:760-717-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer