Provider Demographics
NPI:1609287762
Name:KEATING, RYAN JOHN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:KEATING
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 W CEDAR AVE
Mailing Address - Street 2:#1406
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1845
Mailing Address - Country:US
Mailing Address - Phone:707-217-3979
Mailing Address - Fax:
Practice Address - Street 1:590 W CEDAR AVE
Practice Address - Street 2:#1406
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1845
Practice Address - Country:US
Practice Address - Phone:707-217-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015942172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker