Healthcare Provider Details

I. General information

NPI: 1285098434
Provider Name (Legal Business Name): RYAN ENZWEILER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 OHIO PIKE STE 203
CINCINNATI OH
45255-3745
US

IV. Provider business mailing address

424 MILLRACE DR
COLD SPRING KY
41076-2190
US

V. Phone/Fax

Practice location:
  • Phone: 513-247-4340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: