Healthcare Provider Details

I. General information

NPI: 1053290148
Provider Name (Legal Business Name): BRECK ALLAN PUTZIER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W MARK ST
WINONA MN
55987-3384
US

IV. Provider business mailing address

7825 UPPER 26TH ST N
OAKDALE MN
55128-4818
US

V. Phone/Fax

Practice location:
  • Phone: 507-457-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: