Provider Demographics
NPI:1841761392
Name:MCDONALD, RYAN WILLIAM (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WILLIAM
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-1426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-2105
Practice Address - Country:US
Practice Address - Phone:615-838-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer