Healthcare Provider Details

I. General information

NPI: 1952827297
Provider Name (Legal Business Name): JESSICA ROSE BRESTEL MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1350
US

IV. Provider business mailing address

1920 OAKDALE AVE APT 209
WEST ST PAUL MN
55118-4636
US

V. Phone/Fax

Practice location:
  • Phone: 612-330-1000
  • Fax:
Mailing address:
  • Phone: 402-570-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: