Provider Demographics
NPI:1821659731
Name:ESENWEIN, RYAN JOSEPH (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:ESENWEIN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 BALCH RD APT 7102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-6409
Mailing Address - Country:US
Mailing Address - Phone:912-492-8480
Mailing Address - Fax:
Practice Address - Street 1:125 SPRAGINS HALL
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35899-6409
Practice Address - Country:US
Practice Address - Phone:256-824-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer