# RYAN SCOTT FONKERT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1114372752
- **Gender:** Man
- **Credential:** MS, ATC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2255A2300X | Athletic Trainer | 084678 | IA | Yes |
| 2255A2300X | Athletic Trainer | 586 | CO | — |

## Other

- **Enumeration date:** 05/02/2016
- **Last updated:** 03/27/2018