Individual
DUSTIN WAYNE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
111 17TH AVE E STE 101, ALEXANDRIA, MN 56308-3734
(320) 762-1144
Mailing address
111 17TH AVE E STE 101, ALEXANDRIA, MN 56308-5274
(320) 762-1144
(320) 762-1935
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3304
MN
Other
Enumeration date
02/26/2020
Last updated
02/26/2020
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