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Organization

GLOBAL ATHLETE VILLAGE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE SMITH ATC (CEO)
(952) 888-4311
Entity
Organization

Contact information

Practice address
3600 W 98TH ST, BLOOMINGTON, MN 55431-2746
(952) 888-4311
Mailing address
PO BOX 20725, BLOOMINGTON, MN 55420-0725

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
MN
103TE1100X
Exercise & Sports Psychologist
MN
1041S0200X
School Social Worker
MN
133N00000X
Nutritionist
MN
2251N0400X
Neurology Physical Therapist
2251S0007X
Sports Physical Therapist
2255A2300X
Athletic Trainer
Primary
MN
225700000X
Massage Therapist
MN
225XN1300X
Neurorehabilitation Occupational Therapist
364SN0800X
Neuroscience Clinical Nurse Specialist
MN

Other

Enumeration date
05/28/2012
Last updated
05/28/2012
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