NPI 1205460458

Dustin Wayne Green, ATCLAT

Practitioner Athletic Trainer Alexandria, MN

Practice location

Address: 111 17th Ave E STE 101, Alexandria, MN 56308-3734
Phone: (320) 762-1144
Mailing address: 111 17th Ave E STE 101, Alexandria, MN 56308-5274

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 3304 (MN)

Other Specialist/Technologist providers in Minnesota →

Registry record

NPI: 1205460458
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Feb 2020
Record last updated: 26 Feb 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.