Active NPI
Ryan David Henry, ATC
- Athletic Trainer
- North Branch, MN
National Provider Identifier
1902090020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2012
- Practice address
- 6241 Main St
Suite 102
North Branch, MN 55056-6597 - Phone
- (651) 674-2179
- Fax
- (651) 674-2696
- NPI assigned
- Aug 31, 2007
- Last updated
- Dec 30, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2012 | MN | Primary |
Addresses
Primary practice location
6241 Main St
Suite 102
North Branch, MN 55056-6597
Mailing address
5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 674-2179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2012 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230595200000",
"number": "1902090020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 FAIRVIEW BLVD",
"city": "WYOMING",
"state": "MN",
"postal_code": "550928013",
"telephone_number": "651-674-2179",
"fax_number": "651-674-2696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6241 MAIN ST",
"address_2": "SUITE 102",
"city": "NORTH BRANCH",
"state": "MN",
"postal_code": "550566597",
"telephone_number": "651-674-2179",
"fax_number": "651-674-2696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "RYAN",
"middle_name": "DAVID",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-31",
"last_updated": "2008-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Branch, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.