Provider Demographics
NPI:1760033682
Name:WARE, RYAN ALEXIS
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ALEXIS
Last Name:WARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19321 MOUNTAIN HWY E # 100
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8450
Mailing Address - Country:US
Mailing Address - Phone:253-846-8918
Mailing Address - Fax:253-846-8126
Practice Address - Street 1:19321 MOUNTAIN HWY E # 100
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8450
Practice Address - Country:US
Practice Address - Phone:253-846-8918
Practice Address - Fax:253-846-8126
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
WAPT61480474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer