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JESSE ANDERSON ATC
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1538661186
Individual Registrant: JESSE ANDERSON ATC
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
102 IVERSON ST W SAINT JOSEPH, MN 56374-4650 US
Tel: 320-226-5380 Fax: --
Tel: 320-226-5380 Fax: --
Contact information for business:
102 IVERSON ST W SAINT JOSEPH, MN 56374-4650 US
Tel: 320-226-5380 Fax: --
Tel: 320-226-5380 Fax: --
Registration Information:
NPI: 1538661186
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
