Individual
RYAN MAUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
Mailing address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001181A
IN
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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