Provider Demographics
NPI:1497163885
Name:DEGON, RYAN NORMAL (MS, ATC, CEAS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:NORMAL
Last Name:DEGON
Suffix:
Gender:M
Credentials:MS, ATC, CEAS
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Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:WORK-FIT AT ALCOA MASSENA OPERATIONS
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-0150
Mailing Address - Country:US
Mailing Address - Phone:315-764-4223
Mailing Address - Fax:315-764-4404
Practice Address - Street 1:PARK AVENUE EAST
Practice Address - Street 2:WORK-FIT AT ALCOA MASSENA OPERATIONS
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662
Practice Address - Country:US
Practice Address - Phone:315-764-4223
Practice Address - Fax:315-764-4404
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002195-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer