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General NPI Number Information
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NPI Number | 1669905667
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Entity Type | Individual
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Provider Name | TANNER RYAN HOWELL ATC
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Gender | Male
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/08/2017
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Provider Practice Location Address
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Address Line | 10700 STAPLES MILL RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-2403
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Country | US
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Telephone | 276-970-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 302 THOMPSON ST
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City | ASHLAND
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State | VA
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Zip | 23005-1427
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Country | US
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Telephone | 276-970-5959
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Fax |
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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 | 0126002218
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License Number State | VA
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