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General NPI Number Information
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NPI Number | 1942943089
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Entity Type | Individual
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Provider Name | JENNA MARIE MYERS LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/17/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1901 W 80 1/2 ST UNIT 226
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City | BLOOMINGTON
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State | MN
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Zip | 55431-5108
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Country | US
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Telephone | 319-329-7008
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 W 80 1/2 ST UNIT 315
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City | BLOOMINGTON
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State | MN
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Zip | 55431-7101
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Country | US
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Telephone | 319-329-7008
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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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