Provider Demographics
NPI:1710177894
Name:PALMER, RYAN ALAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALAN
Last Name:PALMER
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 1:4499 N MULE TRAIN DR
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84720-9688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:763 S 1000 W
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2939
Practice Address - Country:US
Practice Address - Phone:435-896-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer