Provider Demographics
NPI:1649489410
Name:RAMOS, BRYON THERON (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:BRYON
Middle Name:THERON
Last Name:RAMOS
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5706
Mailing Address - Country:US
Mailing Address - Phone:618-242-6337
Mailing Address - Fax:618-242-6342
Practice Address - Street 1:1129 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5706
Practice Address - Country:US
Practice Address - Phone:618-242-6337
Practice Address - Fax:618-242-6342
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer