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General NPI Number Information
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NPI Number | 1326460056
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Entity Type | Individual
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Provider Name | RYAN DEANE MS, ATC, CES
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Gender | Male
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 2213 SUMMIT STREET ATHLETIC TRAINING
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City | KENT
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State | OH
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Zip | 44242
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Country | US
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Telephone | 330-672-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 306 NORTHEAST AVE APT. D201
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City | TALLMADGE
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State | OH
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Zip | 44278-1405
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Country | US
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Telephone | 810-923-7515
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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 | AT1077
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.004677
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License Number State | OH
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