Provider Demographics
NPI:1497239594
Name:GRABER, RYAN JAMES (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:GRABER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 OLDE ORCHARD TRL
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-8901
Mailing Address - Country:US
Mailing Address - Phone:330-605-1915
Mailing Address - Fax:
Practice Address - Street 1:4061 OLDE ORCHARD TRL
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-8901
Practice Address - Country:US
Practice Address - Phone:330-605-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer