Provider Demographics
NPI:1659521433
Name:FRIES, RYAN A (MS, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:FRIES
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 N STREEPER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1252
Mailing Address - Country:US
Mailing Address - Phone:410-404-6494
Mailing Address - Fax:
Practice Address - Street 1:1000 HILLTOP CIR
Practice Address - Street 2:RAC 221
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21250-0001
Practice Address - Country:US
Practice Address - Phone:410-455-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00004312255A2300X
PART0044122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer