Healthcare Provider Details

I. General information

NPI: 1841689544
Provider Name (Legal Business Name): RYAN MARIE REH MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 ROSLYN ST UNIT 200
DENVER CO
80238-3324
US

IV. Provider business mailing address

6 ABLE LN
LARAMIE WY
82072-9535
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-3668
  • Fax: 720-553-2778
Mailing address:
  • Phone: 307-399-3098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0002088
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: