Provider Demographics
NPI:1952559429
Name:MCGLADREY, RYAN (LMT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MCGLADREY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW WALL ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2731
Mailing Address - Country:US
Mailing Address - Phone:541-788-2001
Mailing Address - Fax:
Practice Address - Street 1:777 NW WALL ST
Practice Address - Street 2:SUITE 304
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2731
Practice Address - Country:US
Practice Address - Phone:541-788-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10992172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist