Provider Demographics
NPI:1578886982
Name:STRATFORD, RYAN NICHOLAS (LMP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:NICHOLAS
Last Name:STRATFORD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7710
Mailing Address - Country:US
Mailing Address - Phone:907-723-7836
Mailing Address - Fax:
Practice Address - Street 1:603 E 8TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6251
Practice Address - Country:US
Practice Address - Phone:360-452-2934
Practice Address - Fax:360-452-7468
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025294225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist