=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821969171
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN MAXWELL MAVES DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2025
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4990 HILLSDALE CIR STE 300
-----------------------------------------------------
City | EL DORADO HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95762-5770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-905-6378
-----------------------------------------------------
Fax | 916-672-0114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 AIRWAY DR STE 175
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89502-6288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-905-6378
-----------------------------------------------------
Fax | 916-672-0114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number | 308689
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------