Provider Demographics
NPI:1629733134
Name:RANTA, RYLAN WESTON
Entity Type:Individual
Prefix:
First Name:RYLAN
Middle Name:WESTON
Last Name:RANTA
Suffix:
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 1:937 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5845
Mailing Address - Country:US
Mailing Address - Phone:817-851-3494
Mailing Address - Fax:
Practice Address - Street 1:937 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5845
Practice Address - Country:US
Practice Address - Phone:817-851-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician