Basic Information
| Provider Information | |||||||||
| NPI: | 1083369060 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PROUD | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32067 HAMILTON CT APT 204A | ||||||||
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| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441395725 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5844 DARROW RD | ||||||||
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| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442363864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306506767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT019631 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.