Provider Demographics
NPI:1811418007
Name:KROSKIE, RYAN MATTHEW (MS,SCAT,ATC,CSCS)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MATTHEW
Last Name:KROSKIE
Suffix:
Gender:M
Credentials:MS,SCAT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DUE WEST
Mailing Address - State:SC
Mailing Address - Zip Code:29639-9000
Mailing Address - Country:US
Mailing Address - Phone:864-379-2131
Mailing Address - Fax:
Practice Address - Street 1:2 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639-9000
Practice Address - Country:US
Practice Address - Phone:864-379-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer