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NPI Code Detail

MEDICARE: MR. RYAN CHARLES MCMAHON MS, ATC, PES

MEDICARE: MR. RYAN CHARLES MCMAHON MS, ATC, PES
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
12255A2300XAthletic Trainer25MT00125500NJ
22255A2300XAthletic TrainerAL4785FL

General Provider Information

NPI Number : 1356678841
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN CHARLES MCMAHON MS, ATC, PES
Provider Business Mailing Address
First Line : 401 N ROME AVE APT 4406
Second Line :
City : TAMPA
State : FL
Zip : 33606-0053
Country : US
Telephone Number : 609-575-2019
Fax Number :
Provider Business Practice Location Address
First Line : 4541 S DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33611-1407
Country : US
Telephone Number : 813-684-2663
Fax Number : 908-685-2413
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2009
Last Update Date : 07/21/2022

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