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General NPI Number Information
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NPI Number | 1871613521
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Entity Type | Individual
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Provider Name | TARA E ANDERSON ATC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 675 E NICOLLET BLVD SUITE #135
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City | BURNSVILLE
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State | MN
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Zip | 55337-6700
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Country | US
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Telephone | 952-892-2650
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Fax | 952-892-2654
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Provider Business Mailing Address
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Address Line | 4705 17TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3613
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Country | US
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Telephone | 612-920-0302
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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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