Provider Demographics
NPI:1609392158
Name:HOLT, RYAN RICHARD I
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RICHARD
Last Name:HOLT
Suffix:I
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 1:24 HOMESTEAD LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3328
Mailing Address - Country:US
Mailing Address - Phone:207-233-8178
Mailing Address - Fax:
Practice Address - Street 1:32 NORTH RIVER STREET
Practice Address - Street 2:
Practice Address - City:HOLDERNESS
Practice Address - State:NH
Practice Address - Zip Code:03245
Practice Address - Country:US
Practice Address - Phone:603-535-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer