MEDICARE: ALEC EDWARD WEIS MS, LAT, ATC, 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	3411	MN

General Provider Information

NPI Number	:	1619454774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEC EDWARD WEIS MS, LAT, ATC, CSCS

Provider Business Mailing Address
First Line	:	2230 ARTHUR ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3911
Country	:	US
Telephone Number	:	763-478-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 109TH AVE N
Second Line	:
City	:	CHAMPLIN
State	:	MN
Zip	:	55316-3475
Country	:	US
Telephone Number	:	763-478-1360
Fax Number	:

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

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	04/03/2023

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