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General NPI Number Information
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NPI Number | 1326543679
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Entity Type | Individual
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Provider Name | RYAN HORTON
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Gender | Male
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 802 TERRY AVE
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City | SEATTLE
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State | WA
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Zip | 98104-1294
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Country | US
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Telephone | 626-824-4513
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Fax |
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Provider Business Mailing Address
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Address Line | 20933 39TH WAY S APT E202
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City | DES MOINES
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State | WA
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Zip | 98198-4344
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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 | A160991755
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License Number State | WA
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