Healthcare Provider Details

I. General information

NPI: 1942999453
Provider Name (Legal Business Name): KYLE ROBBINS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S WASHINGTON ST
GRAND FORKS ND
58201-7245
US

IV. Provider business mailing address

4440 S WASHINGTON ST
GRAND FORKS ND
58201-7245
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number805-18
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: