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1841655305
JEFFREY FORT
BURNSVILLE, MN
NPI
1841655305
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: MN 2290)
Enumeration Date
2015-12-28
Last Update Date
2015-12-28
Business Address
-- JEFFREY FORT ATC
14101 FAIRVIEW DR SUIT3 300
BURNSVILLE, MN 55337-4590
Phone number: 952-892-2650
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Mailing Address
-- JEFFREY FORT ATC
314 BELLE AIRE DR
CHAMPLIN, MN 55316-1204
Phone number: 763-567-0227
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