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General NPI Number Information
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NPI Number | 1932872967
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Entity Type | Individual
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Provider Name | AUBREY DUDLEY LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 1000 W 140TH ST UNIT 201
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City | BURNSVILLE
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State | MN
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Zip | 55337-4833
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Country | US
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Telephone | 651-357-7154
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Fax |
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Provider Business Mailing Address
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Address Line | 10184 COUNTRY CLUB CURV
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City | WOODBURY
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State | MN
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Zip | 55129-4212
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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 | 3158
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License Number State | MN
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