Provider Demographics
NPI:1821499047
Name:LINDLEY, RYAN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LINDLEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 BRAMPTON AVE
Mailing Address - Street 2:APT. 525
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 BRAMPTON AVE
Practice Address - Street 2:APT. 525
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0847
Practice Address - Country:US
Practice Address - Phone:336-413-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-07
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0025012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer