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General NPI Number Information
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NPI Number | 1497163885
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Entity Type | Individual
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Provider Name | RYAN NORMAL DEGON MS, ATC, CEAS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | PARK AVENUE EAST WORK-FIT AT ALCOA MASSENA OPERATIONS
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City | MASSENA
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State | NY
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Zip | 13662
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Country | US
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Telephone | 315-764-4223
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Fax | 315-764-4404
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Provider Business Mailing Address
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Address Line | PO BOX 150 WORK-FIT AT ALCOA MASSENA OPERATIONS
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City | MASSENA
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State | NY
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Zip | 13662-0150
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Country | US
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Telephone | 315-764-4223
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Fax | 315-764-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 002195-1
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License Number State | NY
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