Healthcare Provider Details

I. General information

NPI: 1952214561
Provider Name (Legal Business Name): MATTHEW COLE PRICE LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 28TH AVE S
MINNEAPOLIS MN
55406-3195
US

IV. Provider business mailing address

8100 NORTHLAND DR
BLOOMINGTON MN
55431-4800
US

V. Phone/Fax

Practice location:
  • Phone: 612-668-4800
  • Fax:
Mailing address:
  • Phone: 952-831-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3978
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: