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NPI Code Detail

MEDICARE: MISS MICHELLE JOAN STRAUCH ATC

MEDICARE: MISS MICHELLE JOAN STRAUCH ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer1404MN

General Provider Information

NPI Number : 1356441299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MICHELLE JOAN STRAUCH ATC
Provider Business Mailing Address
First Line : 4217 40TH AVE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2270
Country : US
Telephone Number : 651-261-1465
Fax Number :
Provider Business Practice Location Address
First Line : 2211 RIVERSIDE AVE
Second Line : CAMPUS BOX 313
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number : 612-330-1310
Fax Number : 612-330-1372
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 07/08/2007

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