Provider Demographics
NPI:1285388538
Name:VALENCIANO, RYAN PLACIDO (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PLACIDO
Last Name:VALENCIANO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:474 LAUKAPU ST STE 2
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4477
Practice Address - Country:US
Practice Address - Phone:808-339-7478
Practice Address - Fax:808-657-4980
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017959225100000X
HIPT-5915-0225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist