| NPI | 1821202078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA LYNN THELEN Owner 651-429-9891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1328) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2020-08-22 |