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Individual
TABITHA MARIE RYAN
Active
Individual
TABITHA MARIE RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005495
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000010996
BOC CERTIFICATION NUMBER
PA
Enumeration date
10/15/2021
Last updated
10/15/2021
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