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General NPI Number Information
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NPI Number | 1598814360
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Entity Type | Individual
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Provider Name | CHAD THOMAS OSGOOD ATC
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3900 BETHEL DR
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City | SAINT PAUL
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State | MN
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Zip | 55112-6902
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Country | US
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Telephone | 651-638-6535
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Fax |
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Provider Business Mailing Address
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Address Line | 200 BURKE AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-6620
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Country | US
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Telephone | 651-488-5301
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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 | 1418
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License Number State | MN
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