Provider Demographics
NPI:1174343032
Name:HALEY, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HALEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STONY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4532
Mailing Address - Country:US
Mailing Address - Phone:443-824-7407
Mailing Address - Fax:
Practice Address - Street 1:4200 5TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:PA
Practice Address - Zip Code:15213-3583
Practice Address - Country:US
Practice Address - Phone:412-624-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer