Provider Demographics
NPI:1669581344
Name:CRITSER, RYAN DEAN (LMP)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DEAN
Last Name:CRITSER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 FERN ST SW APT 32-203
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1134
Mailing Address - Country:US
Mailing Address - Phone:360-570-9580
Mailing Address - Fax:
Practice Address - Street 1:1100 FERN ST SW APT 32-203
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1134
Practice Address - Country:US
Practice Address - Phone:360-570-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0200980OtherDEPT. OF L&I