Provider Demographics
NPI:1497469654
Name:THREATT, RYAN (MAED, BCHC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:THREATT
Suffix:
Gender:M
Credentials:MAED, BCHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 REDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-7153
Mailing Address - Country:US
Mailing Address - Phone:205-837-9092
Mailing Address - Fax:
Practice Address - Street 1:185 REDSTONE WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-7153
Practice Address - Country:US
Practice Address - Phone:205-837-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBO1019731171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach