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Organization
GLOBAL ATHLETE VILLAGE
Active
Organization
GLOBAL ATHLETE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE SMITH ATC (CEO)
(952) 888-4311
Entity
Organization
Contact information
Practice address
3600 W 98TH ST, BLOOMINGTON, MN 55431-2746
(952) 888-4311
Mailing address
PO BOX 20725, BLOOMINGTON, MN 55420-0725
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
MN
103TE1100X
Exercise & Sports Psychologist
—
MN
1041S0200X
School Social Worker
—
MN
133N00000X
Nutritionist
—
MN
2251N0400X
Neurology Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
—
—
2255A2300X
Athletic Trainer
Primary
—
MN
225700000X
Massage Therapist
—
MN
225XN1300X
Neurorehabilitation Occupational Therapist
—
—
364SN0800X
Neuroscience Clinical Nurse Specialist
—
MN
Other
Enumeration date
05/28/2012
Last updated
05/28/2012
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