MEDICARE: AMBER LYNN RYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1194950931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LYNN RYAN

Provider Business Mailing Address
First Line	:	6330 WHISPERING OAKS DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-1229
Country	:	US
Telephone Number	:	952-334-3119
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 WHISPERING OAKS DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-1229
Country	:	US
Telephone Number	:	952-334-3119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/22/2009

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Directions to “ AMBER LYNN RYAN ” Practice Location

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