Provider Demographics
NPI:1598097727
Name:ASHWORTH, RYAN (MS, ATC, PMP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ASHWORTH
Suffix:
Gender:
Credentials:MS, ATC, PMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 YOUNG FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR JOHNSON A F B
Practice Address - State:NC
Practice Address - Zip Code:27531-2554
Practice Address - Country:US
Practice Address - Phone:919-722-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2025-02-24
Deactivation Date:2010-06-24
Deactivation Code:
Reactivation Date:2010-12-29
Provider Licenses
StateLicense IDTaxonomies
VA01260015052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer