Provider Demographics
NPI:1528716008
Name:KINION, RYAN WILLIAM
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:KINION
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 1:8057 N BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3736
Mailing Address - Country:US
Mailing Address - Phone:503-467-8689
Mailing Address - Fax:
Practice Address - Street 1:8057 N BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3736
Practice Address - Country:US
Practice Address - Phone:503-467-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist