Provider Demographics
NPI:1609297829
Name:RUBEN, RYAN MICHAEL (PT, MS, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:RUBEN
Suffix:
Gender:M
Credentials:PT, MS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-1005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:344B CHURCH ST S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1512
Practice Address - Country:US
Practice Address - Phone:304-373-0093
Practice Address - Fax:304-372-5764
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810028726Medicaid
OH0139686Medicaid
OH0139686Medicaid