Provider Demographics
NPI:1205348547
Name:ISHIHARA, RYAN (ATC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ISHIHARA
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 1:765 14TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2611
Mailing Address - Country:US
Mailing Address - Phone:503-399-3241
Mailing Address - Fax:
Practice Address - Street 1:765 14TH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2611
Practice Address - Country:US
Practice Address - Phone:808-292-6907
Practice Address - Fax:808-292-6907
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101825042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer