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General NPI Number Information
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NPI Number | 1134783822
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Entity Type | Individual
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Provider Name | RYAN SHROYER MT
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Gender | Male
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Dates
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Enumeration Date | 04/28/2019
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 2727 N TEJON ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6231
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Country | US
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Telephone | 719-439-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 8760 SHREVEPORT RD
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City | PEYTON
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State | CO
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Zip | 80831-6732
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Country | US
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Telephone | 719-439-1892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0022562
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License Number State | CO
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