Provider Demographics
NPI:1467856757
Name:LEDWON, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LEDWON
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 1:5808 COPPER BEECH BLVD
Mailing Address - Street 2:APT C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5703
Mailing Address - Country:US
Mailing Address - Phone:708-415-3176
Mailing Address - Fax:
Practice Address - Street 1:5808 COPPER BEECH BLVD
Practice Address - Street 2:APT C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5717
Practice Address - Country:US
Practice Address - Phone:708-415-3176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer