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General NPI Number Information
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NPI Number | 1649662560
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Entity Type | Individual
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Provider Name | RYAN FOWERS MS ATC-L CSCS
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Gender | Male
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 3584 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-5710
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Country | US
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Telephone | 801-568-3480
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Fax | 801-568-3482
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Provider Business Mailing Address
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Address Line | 3584 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-5710
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Country | US
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Telephone | 801-568-3480
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Fax | 801-568-3482
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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 | 2000004896
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License Number State | UT
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