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General NPI Number Information
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NPI Number | 1003278813
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Entity Type | Individual
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Provider Name | BLAINE ANTHONY BIRTZER DAT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1536 HEWITT AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-1284
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Country | US
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Telephone | 651-523-3094
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Fax |
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Provider Business Mailing Address
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Address Line | 1536 HEWITT AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-1205
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Country | US
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Telephone | 715-214-3898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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