Ryan Spencer Fought, ATC
Individual provider Active NPI Athletic Trainer · Culver, IN
NPI 1972889111 · NPPES record last updated Nov 2, 2011
Key facts
- NPI
- 1972889111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 36001799A (IN)
- Practice address
- 1300 Academy Rd # 921
Culver, IN 46511-1234 - Phone
- (574) 842-8299
- NPI assigned
- Nov 2, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36001799A | IN | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36001799A | IN | Yes |
Addresses
Primary practice location
1300 Academy Rd # 921
Culver, IN 46511-1234
Mailing address
1300 Academy Rd # 921
Culver, IN 46511-1234
Phone (574) 842-8299
Other providers in Culver, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.