Provider Demographics
NPI:1679960215
Name:MARINO, RYAN (LMP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 11TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6642
Mailing Address - Country:US
Mailing Address - Phone:206-450-1605
Mailing Address - Fax:
Practice Address - Street 1:1002 11TH ST APT 4
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6642
Practice Address - Country:US
Practice Address - Phone:206-450-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60199623172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist