Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
RYAN JOE WALLACE, RT (R)
Active Sole ProprietorRYAN JOE WALLACE, RT (R) is a Body Imaging healthcare provider located in MOSCOW, Idaho. NPI 1770370488 is currently active in the NPPES registry. Verify at CMS.
Body Imaging · MOSCOW, ID
Registration Details
- NPI Number
- 1770370488
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 24, 2025 (1.1212553365607 yrs)
- Last Updated
- Apr 24, 2025
- License
-
386921 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2500 W A ST STE 201MOSCOW, ID, 838436000Browse ID providers · Browse ZIP 83843
- Phone
- 2085968408
- Primary Specialty
-
Body Imaging
2085B0100X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.