Individual
JOHN GAGE RYDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
1605 GRAND CENTRAL AVE, VIENNA, WV 26105-1081
(304) 295-7290
(304) 295-5922
Mailing address
1605 GRAND CENTRAL AVE, VIENNA, WV 26105-1081
(304) 295-7290
(304) 295-5922
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004414
WV
2255A2300X
Athletic Trainer
2000020739
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356766059
—
WV
Enumeration date
09/07/2017
Last updated
11/05/2022
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