Healthcare Provider Details

I. General information

NPI: 1447631767
Provider Name (Legal Business Name): AMANDA KRUSE MBA, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SCHMALTZ

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 COMMERCE DR.
NORTH MANKATO MN
56003
US

IV. Provider business mailing address

1681 COMMERCE DR.
NORTH MANKATO MN
56003
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-8017
  • Fax: 507-625-2325
Mailing address:
  • Phone: 507-625-8017
  • Fax: 507-625-2325

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: