Provider Demographics
NPI:1770115172
Name:GLACKMAN, RYAN DOUGLAS (ATC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DOUGLAS
Last Name:GLACKMAN
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 1:5235 PICKET DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3621
Mailing Address - Country:US
Mailing Address - Phone:719-510-3805
Mailing Address - Fax:
Practice Address - Street 1:1 KELLOGG CIR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5087
Practice Address - Country:US
Practice Address - Phone:620-341-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer