Individual
RYAN HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
68 REPRESENTATIVE LN, DOVER, DE 19904-2491
(301) 693-5951
Mailing address
68 REPRESENTATIVE LN, DOVER, DE 19904-2491
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J3-0000588
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000016850
CERTIFIED ATHLETIC TRAINER
—
01
—
J3-0000588
DELAWARE STATE LICENSED ATHLETIC TRAINER
DE
Enumeration date
10/06/2017
Last updated
10/06/2017
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