Healthcare Provider Details

I. General information

NPI: 1972823474
Provider Name (Legal Business Name): ANGELA M RYAN RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA M RYAN RMT

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31207 KEATS WAY STE 104
EVERGREEN CO
80439-2215
US

IV. Provider business mailing address

31207 KEATS WAY STE 104
EVERGREEN CO
80439-2215
US

V. Phone/Fax

Practice location:
  • Phone: 303-907-4829
  • Fax:
Mailing address:
  • Phone: 303-907-4829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9456
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: