Healthcare Provider Details

I. General information

NPI: 1699478776
Provider Name (Legal Business Name): RYAN DARNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 JENKINS MEMORIAL RD
WELLSTON OH
45692-9561
US

IV. Provider business mailing address

509 E A ST
WELLSTON OH
45692-1307
US

V. Phone/Fax

Practice location:
  • Phone: 740-384-2119
  • Fax:
Mailing address:
  • Phone: 740-418-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA009304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: