MEDICARE: DANIELLE ANN PULKRABEK ATR, CSCS

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
1	2255A2300X	Athletic Trainer	1914	MN

General Provider Information

NPI Number	:	1306806559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ANN PULKRABEK ATR, CSCS

Provider Business Mailing Address
First Line	:	3145 HARBOR LN N
Second Line	:	APT. 1-301
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-5124
Country	:	US
Telephone Number	:	763-519-1228
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 COMMERCE BLVD
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1547
Country	:	US
Telephone Number	:	952-495-2125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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