Individual
JACOB RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S. ATC
Contact information
Practice address
521 LANCASTER AVENUE, 115 ALUMNI COLISEUM, RICHMOND, KY 40475
(859) 622-8174
Mailing address
521 LANCASTER AVENUE, 115 ALUMNI COLISEUM, RICHMOND, KY 40475
(859) 622-8174
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT495
KY
Other
Enumeration date
12/12/2013
Last updated
12/12/2013
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