Individual
MR. RYAN EDWARD VANDERVEST
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MS, LAT, CSCS
Contact information
Practice address
760 PILGRIM WAY, GREEN BAY, WI 54304-5263
(920) 496-4750
Mailing address
2840 CHAR LA MAR DR, GREEN BAY, WI 54311-6573
(920) 496-4750
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
626-039
WI
Other
Enumeration date
02/17/2006
Last updated
07/08/2007
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