Provider Demographics
NPI:1629221106
Name:FENTON, RYAN THOMAS (DPT, MTC, CERTDN,CCI)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:FENTON
Suffix:
Gender:M
Credentials:DPT, MTC, CERTDN,CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOREST EDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-9539
Mailing Address - Country:US
Mailing Address - Phone:828-785-8388
Mailing Address - Fax:828-333-4898
Practice Address - Street 1:24 SARDIS RD
Practice Address - Street 2:SUITE B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-9564
Practice Address - Country:US
Practice Address - Phone:828-785-8388
Practice Address - Fax:828-333-4898
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11798225100000X
CO103562251X0800X
NC11798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic