Provider Demographics
NPI:1568020550
Name:RICE, RYAN KEITH
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:KEITH
Last Name:RICE
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 1:37820 COUNTRY WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9042
Mailing Address - Country:US
Mailing Address - Phone:907-953-9901
Mailing Address - Fax:
Practice Address - Street 1:35514 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7655
Practice Address - Country:US
Practice Address - Phone:907-953-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1060392172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist