Individual
ALYSSA ROSE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2104 NORTHDALE BLVD NW STE 100, COON RAPIDS, MN 55433
(763) 755-5495
Mailing address
20540 GEORGIA AVE N, FOREST LAKE, MN 55025-8009
(612) 558-7932
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000033575
MN
Other
Enumeration date
01/25/2018
Last updated
07/10/2018
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