Healthcare Provider Details

I. General information

NPI: 1275300873
Provider Name (Legal Business Name): SONJA SQUIERS MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 COLLEGE VIEW DR
SAINT BONIFACIUS MN
55375-9001
US

IV. Provider business mailing address

8700 COLLEGE VIEW DR
SAINT BONIFACIUS MN
55375-9002
US

V. Phone/Fax

Practice location:
  • Phone: 763-221-7354
  • Fax:
Mailing address:
  • Phone: 763-221-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3810
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: