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General NPI Number Information
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NPI Number | 1396662839
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Entity Type | Individual
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Provider Name | RYAN REYNOLDS
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Gender | Male
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 4870 SADLER RD STE 300
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6294
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 9609 SEVEN SISTERS DR
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City | ASHLAND
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State | VA
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Zip | 23005-7564
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Country | US
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Telephone | 845-702-8501
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133005222
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License Number State | VA
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