Healthcare Provider Details

I. General information

NPI: 1326972373
Provider Name (Legal Business Name): REBECCA MAILAND LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MAILAND

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 FORD PKWY
SAINT PAUL MN
55116-1931
US

IV. Provider business mailing address

1758 BLUEBILL CIR
EAGAN MN
55122-1124
US

V. Phone/Fax

Practice location:
  • Phone: 612-256-8225
  • Fax:
Mailing address:
  • Phone:
  • 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: