Healthcare Provider Details

I. General information

NPI: 1306753249
Provider Name (Legal Business Name): RYAN JACOB UNGARO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15412 E SPRAGUE AVE STE 8
SPOKANE VALLEY WA
99037-8841
US

IV. Provider business mailing address

2021 S LIBERTY DR
LIBERTY LAKE WA
99019-9782
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-9098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70166212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: