Individual
RYAN DAVID HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
6241 MAIN ST, SUITE 102, NORTH BRANCH, MN 55056-6597
(651) 674-2179
(651) 674-2696
Mailing address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 674-2179
(651) 674-2696
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2012
MN
Other
Enumeration date
08/31/2007
Last updated
12/30/2008
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