Individual
MR. RYAN NEAL WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A.T., ATC
Contact information
Practice address
1200 MAGNOLIA WAY, PROGRESSIVE HEALTH (ESI), BLUE SPRINGS, MS 38828-6000
(662) 317-3229
Mailing address
1200 MAGNOLIA WAY, PROGRESSIVE HEALTH (ESI), BLUE SPRINGS, MS 38828-6000
(662) 317-3229
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1058
AL
Other
Enumeration date
07/04/2012
Last updated
07/04/2012
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