Provider Demographics
NPI:1326593724
Name:GEBUR, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:GEBUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 REDPOLL AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-6824
Mailing Address - Country:US
Mailing Address - Phone:952-913-7506
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGHLAND CTR
Practice Address - Street 2:ATHLETIC TRAINING - DEPARTMENT OF HUMAN PERFORMANCE
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6537
Practice Address - Country:US
Practice Address - Phone:507-389-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer