Provider Demographics
NPI:1598367773
Name:STABLER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:STABLER
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 1:8475 S EASTERN AVE STE 105A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2863
Mailing Address - Country:US
Mailing Address - Phone:725-209-2049
Mailing Address - Fax:
Practice Address - Street 1:8475 S EASTERN AVE STE 105A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2863
Practice Address - Country:US
Practice Address - Phone:725-209-2049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist