Provider Demographics
NPI:1699890269
Name:HEDWALL, RYAN (MA,LAT,ATC,OTC,BCS-O)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HEDWALL
Suffix:
Gender:M
Credentials:MA,LAT,ATC,OTC,BCS-O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 LAWSON AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3237
Mailing Address - Country:US
Mailing Address - Phone:714-305-2304
Mailing Address - Fax:
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2533
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
110302077OtherBOARD OF CERTIFICATION - ATC
3000100026OtherBOARD OF CERTIFICATION - ORTHOPEDIC SPECIALTY