Provider Demographics
NPI:1194912063
Name:PALOMBIT, RYAN VICTOR
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:VICTOR
Last Name:PALOMBIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12906 PLEASANT VIEW LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3604
Mailing Address - Country:US
Mailing Address - Phone:317-590-1064
Mailing Address - Fax:
Practice Address - Street 1:12906 PLEASANT VIEW LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3604
Practice Address - Country:US
Practice Address - Phone:317-590-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002248A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant