Provider Demographics
NPI:1013690445
Name:MONTAG, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MONTAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3213 SUMMERDALE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4627
Mailing Address - Country:US
Mailing Address - Phone:614-208-5750
Mailing Address - Fax:
Practice Address - Street 1:3213 SUMMERDALE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-4627
Practice Address - Country:US
Practice Address - Phone:614-208-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Yes253Z00000XAgenciesIn Home Supportive Care