Provider Demographics
NPI:1740650324
Name:RYAN, SUMMER (LMT)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 SW RIMROCK WAY STE A
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1964
Mailing Address - Country:US
Mailing Address - Phone:541-815-8159
Mailing Address - Fax:
Practice Address - Street 1:668 SW RIMROCK WAY STE A
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1964
Practice Address - Country:US
Practice Address - Phone:541-815-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15720172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist