Provider Demographics
NPI:1134760499
Name:SWOVERLAND, RYAN J (LMT)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:SWOVERLAND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1389 FLORIDA RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4472
Mailing Address - Country:US
Mailing Address - Phone:970-426-9256
Mailing Address - Fax:
Practice Address - Street 1:1389 FLORIDA RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4472
Practice Address - Country:US
Practice Address - Phone:970-426-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CO225700000X
CO0003492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty