Provider Demographics
NPI:1053929547
Name:LACOMBE, RYAN THOMAS ANDREW (LAT, ATC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS ANDREW
Last Name:LACOMBE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 SW SUMMIT WOODS DR APT 5
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1442
Mailing Address - Country:US
Mailing Address - Phone:785-280-3216
Mailing Address - Fax:
Practice Address - Street 1:1700 SW COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66621-0001
Practice Address - Country:US
Practice Address - Phone:785-670-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-014772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS051085941OtherMUTUAL OF OMAHA