Healthcare Provider Details

I. General information

NPI: 1881008365
Provider Name (Legal Business Name): RYAN CONNERS ATC/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BEDFORD WAY
FRANKLIN TN
37064-5526
US

IV. Provider business mailing address

1555 CENTER POINTE DR
MURFREESBORO TN
37130-1820
US

V. Phone/Fax

Practice location:
  • Phone: 615-790-3290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0000001243
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: