MEDICARE: LEAH DARGIS

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
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1881221430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH DARGIS

Provider Business Mailing Address
First Line	:	10516 ZION AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-2733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10516 ZION AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-2733
Country	:	US
Telephone Number	:	952-500-2597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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Directions to “ LEAH DARGIS ” Practice Location

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