Individual
RYAN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC-L, CES
Contact information
Practice address
5670 W RED RIDGE LN, SALT LAKE CITY, UT 84118-5004
(801) 865-1239
Mailing address
5670 W RED RIDGE LN, SALT LAKE CITY, UT 84118-5004
(801) 865-1239
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
7913172-4810
UT
Other
Enumeration date
09/03/2014
Last updated
09/03/2014
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