Provider Demographics
NPI:1457673006
Name:HOLLEMAN, RYAN MICHAEL (MED, LAT, ATC, CES)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MICHAEL
Last Name:HOLLEMAN
Suffix:
Gender:M
Credentials:MED, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2500 WARREN CARROLL DR
Mailing Address - Street 2:BOX 8502
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27695-8502
Mailing Address - Country:US
Mailing Address - Phone:919-515-6992
Mailing Address - Fax:919-515-6056
Practice Address - Street 1:2500 WARREN CARROLL DR
Practice Address - Street 2:BOX 8502
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27695-8502
Practice Address - Country:US
Practice Address - Phone:919-515-6992
Practice Address - Fax:919-515-6056
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer