Provider Demographics
NPI:1952751943
Name:SACKO, RYAN (ATC CSCS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SACKO
Suffix:
Gender:M
Credentials:ATC CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 LONGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2249
Mailing Address - Country:US
Mailing Address - Phone:803-447-2367
Mailing Address - Fax:
Practice Address - Street 1:1300 WHEAT ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-447-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator