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1285609941
RYAN EDWARD VANDERVEST
GREEN BAY, WI
NPI
1285609941
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: WI 626-039)
Enumeration Date
2006-02-17
Last Update Date
2007-07-08
Business Address
Mr. RYAN EDWARD VANDERVEST MS, LAT, CSCS
760 PILGRIM WAY
GREEN BAY, WI 54304-5263
Phone number: 920-496-4750
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Mailing Address
Mr. RYAN EDWARD VANDERVEST MS, LAT, CSCS
2840 CHAR LA MAR DR
GREEN BAY, WI 54311-6573
Phone number: 920-496-4750
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