Individual
STACEY JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, OTC
Contact information
Practice address
3580 ARCADE ST, VADNAIS HEIGHTS, MN 55127-7135
(651) 968-5375
(651) 968-5907
Mailing address
1285 NININGER RD, HASTINGS, MN 55033-1086
(651) 968-5413
(651) 437-2988
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2280
MN
246ZC0007X
Surgical Assistant
18-2775
MN
Other
Enumeration date
06/12/2014
Last updated
01/29/2020
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