Provider Demographics
NPI:1598097727
Name:ASHWORTH, RYAN (ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ASHWORTH
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:PO BOX 6654
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-0654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2955 S GLEBE RD STE E
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2730
Practice Address - Country:US
Practice Address - Phone:609-472-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2010-12-29
Deactivation Date:2010-06-24
Deactivation Code:
Reactivation Date:2010-12-29
Provider Licenses
StateLicense IDTaxonomies
VA01260015052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer