Provider Demographics
NPI:1437881729
Name:WIEBUSCH, RYAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:WIEBUSCH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 DETROIT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-3909
Mailing Address - Country:US
Mailing Address - Phone:440-240-9111
Mailing Address - Fax:440-934-5459
Practice Address - Street 1:5445 DETROIT RD STE 201
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44054-3909
Practice Address - Country:US
Practice Address - Phone:440-240-9111
Practice Address - Fax:440-934-5459
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025291225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist