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General NPI Number Information
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NPI Number | 1265816573
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Entity Type | Individual
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Provider Name | RYAN KACVINSKY
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Gender | Male
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 1008 LEIGHSFORD LN APT 12206
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City | ARLINGTON
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State | TX
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Zip | 76006-3808
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Country | US
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Telephone | 715-292-1690
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Fax |
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Provider Business Mailing Address
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Address Line | 701 S NEDDERMAN DR
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City | ARLINGTON
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State | TX
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Zip | 76019-9800
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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