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General NPI Number Information
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NPI Number | 1083641641
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Entity Type | Individual
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Provider Name | JESSICA BETH LINZ ATC, ATR
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11200 MISSISSIPPI BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-3470
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Country | US
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Telephone | 763-433-1289
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Fax |
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Provider Business Mailing Address
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Address Line | 11585 103RD AVE NE
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City | FOLEY
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State | MN
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Zip | 56329-9305
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Country | US
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Telephone |
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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 | 1817
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License Number State | MN
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