Provider Demographics
NPI:1669905667
Name:HOWELL, TANNER RYAN (ATC)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:RYAN
Last Name:HOWELL
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 1:302 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1427
Mailing Address - Country:US
Mailing Address - Phone:276-970-5959
Mailing Address - Fax:
Practice Address - Street 1:10700 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2403
Practice Address - Country:US
Practice Address - Phone:276-970-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260022182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer