Provider Demographics
NPI:1699215319
Name:HERST, RYAN M (CMT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:HERST
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 JESSAMINE AVE W
Mailing Address - Street 2:APT 307
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2684
Mailing Address - Country:US
Mailing Address - Phone:763-742-7681
Mailing Address - Fax:
Practice Address - Street 1:1445 JESSAMINE AVE W
Practice Address - Street 2:APT 307
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2684
Practice Address - Country:US
Practice Address - Phone:763-742-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist