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General NPI Number Information
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NPI Number | 1366583593
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Entity Type | Individual
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Provider Name | ANNA JEAN BRATSCH ATC
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Gender | Female
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 901 8TH ST S
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City | MOORHEAD
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State | MN
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Zip | 56562-0001
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Country | US
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Telephone | 218-299-4208
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 43 1/2ST SW 204
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City | FARGO
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State | ND
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Zip | 58103
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Country | US
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Telephone | 320-295-2232
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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 | 1919
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License Number State | MN
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