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General NPI Number Information
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NPI Number | 1457278657
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE KLOFSTAD LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 515 5TH AVE W
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City | GRAND MARAIS
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State | MN
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Zip | 55604-3017
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Country | US
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Telephone | 218-387-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 58 HAYS CIR
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City | SILVER BAY
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State | MN
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Zip | 55614-1242
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Country | US
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Telephone | 763-614-4159
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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 | 3503
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License Number State | MN
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