Individual
MR. BRIAN RIDDERUS OUDYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT, CAT(C)
Contact information
Practice address
980 KELLY JOHNSON DR STE 200, LAS VEGAS, NV 89119-3768
(702) 352-0200
Mailing address
216 SUMMER PALACE WAY, LAS VEGAS, NV 89144-4116
(702) 265-6058
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0506201
NV
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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