Individual
MOLLY ANN VANDERBOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., ATC, LAT, OPE
Contact information
Practice address
5155 55TH ST NW, ROCHESTER, MN 55901-3855
(507) 292-7174
Mailing address
1001 EAGLE VISTA LN, LAKE CITY, MN 55041-4413
(319) 360-8286
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2668
MN
Other
Enumeration date
10/19/2021
Last updated
10/19/2021
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