Healthcare Provider Details

I. General information

NPI: 1588376131
Provider Name (Legal Business Name): ANDREW CURTIS ENGEBRETSON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 PERIMETER DR
MOSCOW ID
83844-4582
US

IV. Provider business mailing address

6018 LITTLE CREEK LN
ROCKFORD MN
55373-4582
US

V. Phone/Fax

Practice location:
  • Phone: 208-885-6394
  • Fax:
Mailing address:
  • Phone: 763-614-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: