Individual
RYAN HEDWALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA,LAT,ATC,OTC,BCS-O
Contact information
Practice address
225 SMITH AVE N, SAINT PAUL, MN 55102-2533
(952) 946-9777
Mailing address
986 LAWSON AVE E, SAINT PAUL, MN 55106-3237
(714) 305-2304
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110302077
BOARD OF CERTIFICATION - ATC
—
01
—
3000100026
BOARD OF CERTIFICATION - ORTHOPEDIC SPECIALTY
—
Enumeration date
03/20/2007
Last updated
04/09/2022
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