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NPI Code Detail

MEDICARE: KELLY ROBISON ATR

MEDICARE: KELLY ROBISON ATR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2224MN

General Provider Information

NPI Number : 1245527605
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ROBISON ATR
Provider Business Mailing Address
First Line : 13700 VALLEY VIEW RD
Second Line : APT 140
City : EDEN PRAIRIE
State : MN
Zip : 55344-1952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7872 CENTURY BLVD
Second Line :
City : CHANHASSEN
State : MN
Zip : 55317-8005
Country : US
Telephone Number : 952-448-9081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2011
Last Update Date : 07/06/2011

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