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General NPI Number Information
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NPI Number | 1285135764
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Entity Type | Individual
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Provider Name | CASEY LEWANDOSKI ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 14050 FAIRVIEW DR FL 1
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City | BURNSVILLE
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State | MN
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Zip | 55337-5713
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Country | US
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Telephone | 952-831-9742
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Fax |
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Provider Business Mailing Address
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Address Line | 13055 DAHLIA CIR APT 218
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7638
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3137
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License Number State | MN
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