Provider Demographics
NPI:1912779711
Name:MASSIE, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MASSIE
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:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-0402
Mailing Address - Country:US
Mailing Address - Phone:740-861-1140
Mailing Address - Fax:
Practice Address - Street 1:25B LEON ALY
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-2020
Practice Address - Country:US
Practice Address - Phone:740-861-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator