Provider Demographics
NPI:1962862896
Name:RICHARD, JOSEPH RYAN (ATC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:RICHARD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1310
Mailing Address - Country:US
Mailing Address - Phone:774-354-0490
Mailing Address - Fax:
Practice Address - Street 1:964 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1310
Practice Address - Country:US
Practice Address - Phone:774-354-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer