Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | MN |
NPI | 1003077439 |
---|---|
Provider Name | Ryan C Hebrink |
First Address | Willmar, MN 56201-4243 |
Second Address | Willmar, MN 56201-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 18/06/2008 |