Individual
RYAN SCOTT FONKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
605 WASHINGTONE STREET, FAYETTE, IA 52142
(563) 425-5664
(563) 425-5188
Mailing address
108 ELIASEN AVE, WAVERLY, IA 50677-4415
(319) 529-1518
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
084678
IA
2255A2300X
Athletic Trainer
586
CO
Other
Enumeration date
05/02/2016
Last updated
03/27/2018
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