Provider Demographics
NPI:1265886725
Name:PRO, RYAN DE' ANGELO
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DE' ANGELO
Last Name:PRO
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 1:10321 WASHINGTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2012
Mailing Address - Country:US
Mailing Address - Phone:720-443-0601
Mailing Address - Fax:
Practice Address - Street 1:10321 WASHINGTON STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:THRONTON
Practice Address - State:CO
Practice Address - Zip Code:80229
Practice Address - Country:US
Practice Address - Phone:720-443-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist