Healthcare Provider Details

I. General information

NPI: 1457325763
Provider Name (Legal Business Name): CHRISTOPHER JASON HUOT ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 7TH AVE S 106 C NEMZEK HALL
MOORHEAD MN
56563-0001
US

IV. Provider business mailing address

3014 34TH ST S
MOORHEAD MN
56560-6937
US

V. Phone/Fax

Practice location:
  • Phone: 218-477-5972
  • Fax:
Mailing address:
  • Phone: 218-477-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1829
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: