Provider Demographics
NPI:1740768399
Name:TROMBLEY, RYAN KENNETH (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:KENNETH
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-2327
Mailing Address - Country:US
Mailing Address - Phone:724-366-4552
Mailing Address - Fax:
Practice Address - Street 1:250 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1341
Practice Address - Country:US
Practice Address - Phone:724-938-5206
Practice Address - Fax:717-412-9972
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA178410146N00000X
PART0058392255A2300X
PAPT027079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer