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General NPI Number Information
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NPI Number | 1598097727
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Entity Type | Individual
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Provider Name | RYAN ASHWORTH MS, ATC, PMP
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Gender | Male
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 1500 LANGLEY AVE
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City | SEYMOUR JOHNSON A F B
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State | NC
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Zip | 27531-2554
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Country | US
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Telephone | 919-722-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 708 YOUNG FOREST DR
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City | WAKE FOREST
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State | NC
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Zip | 27587-9040
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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 | 0126001505
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License Number State | VA
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