Provider Demographics
NPI:1134828247
Name:RYAN, RENEE SOMAR (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:SOMAR
Last Name:RYAN
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 EKLUND AVENUE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1334
Mailing Address - Country:US
Mailing Address - Phone:830-352-9097
Mailing Address - Fax:
Practice Address - Street 1:0S 165 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1245
Practice Address - Country:US
Practice Address - Phone:630-352-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.000464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist