Provider Demographics
NPI:1790172047
Name:DIPANFILO, RYAN (ATC, CSCS, CES)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DIPANFILO
Suffix:
Gender:M
Credentials:ATC, CSCS, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2438
Mailing Address - Country:US
Mailing Address - Phone:602-462-6228
Mailing Address - Fax:602-462-6227
Practice Address - Street 1:401 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2438
Practice Address - Country:US
Practice Address - Phone:602-462-6228
Practice Address - Fax:602-462-6227
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer