Provider Demographics
NPI:1588491476
Name:RYAN, SAYGE (CTRS)
Entity type:Individual
Prefix:
First Name:SAYGE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:SAYGE
Other - Middle Name:
Other - Last Name:DUNNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6728 DEL RIO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-1711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6728 DEL RIO DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-1711
Practice Address - Country:US
Practice Address - Phone:260-494-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87569225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist