Individual
RYDER FROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2250 THUNDERSTICK DR, LEXINGTON, KY 40505-9010
(859) 361-7357
Mailing address
2250 THUNDERSTICK DR, LEXINGTON, KY 40505-9010
(859) 361-7357
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
05/31/2023
Last updated
01/10/2025
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