Individual
KAYLA UPTAGRAFFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
9555 UPLAND LANE NORH, MAPLE GROVE, MN 55369
(952) 806-5600
Mailing address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2900
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000012006
BOARD OF CERTIFICATION
—
01
—
2900
MINNESOTA BOARD OF MEDICAL PRACTICE
MN
Enumeration date
02/13/2017
Last updated
02/13/2017
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