Provider Demographics
NPI:1588897185
Name:RYDER, JANAE (LOA-CO)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:RYDER
Suffix:
Gender:F
Credentials:LOA-CO
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:
Other - Last Name:HALTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LOA-CO
Mailing Address - Street 1:5222 BURNET RD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2432
Mailing Address - Country:US
Mailing Address - Phone:512-302-4838
Mailing Address - Fax:
Practice Address - Street 1:5222 BURNET RD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2432
Practice Address - Country:US
Practice Address - Phone:512-302-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist