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 |