Provider Demographics
NPI:1427363266
Name:HORNBACK, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HORNBACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MAKAWAO AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8859
Mailing Address - Country:US
Mailing Address - Phone:808-572-2281
Mailing Address - Fax:808-573-5869
Practice Address - Street 1:81 MAKAWAO AVE STE 110
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8859
Practice Address - Country:US
Practice Address - Phone:808-572-2281
Practice Address - Fax:808-573-5869
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist