Provider Demographics
NPI:1629462841
Name:RATKOVSKY, RYAN (MS, ATC, PES)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:RATKOVSKY
Suffix:
Gender:M
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 COPPER DR APT 201
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3879
Mailing Address - Country:US
Mailing Address - Phone:814-450-4345
Mailing Address - Fax:
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-877-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0042072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer