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General NPI Number Information
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NPI Number | 1083132955
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Entity Type | Individual
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Provider Name | JACK GASPERLIN ATC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 100 FALLWOOD RD
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City | REDWOOD FALLS
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State | MN
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Zip | 56283-1828
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Country | US
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Telephone | 507-637-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 941 E OAK ST APT 101
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City | REDWOOD FALLS
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State | MN
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Zip | 56283-1345
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Country | US
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Telephone | 907-441-8053
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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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