Provider Demographics
NPI:1588231625
Name:HAMNER, RYAN DWAYNE (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DWAYNE
Last Name:HAMNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 MOUNT VERNON DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2220
Mailing Address - Country:US
Mailing Address - Phone:407-619-5845
Mailing Address - Fax:
Practice Address - Street 1:150 SHORESIDE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6433
Practice Address - Country:US
Practice Address - Phone:859-721-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist