Provider Demographics
NPI:1619404951
Name:RIBANT, MARCUS (AT, ATC)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:RIBANT
Suffix:
Gender:M
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUNSET HILLS AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-5842
Mailing Address - Country:US
Mailing Address - Phone:810-444-5354
Mailing Address - Fax:
Practice Address - Street 1:18 SUNSET HILLS AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-5842
Practice Address - Country:US
Practice Address - Phone:810-444-5354
Practice Address - Fax:810-444-5354
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010009692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty