Individual
BRADLEY ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
106 FOXBOROUGH LN, LE SUEUR, MN 56058-1606
(612) 619-0101
Mailing address
106 FOXBOROUGH LN, LE SUEUR, MN 56058-1606
(612) 619-0101
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2255A2300X
MN
Other
Enumeration date
01/10/2019
Last updated
01/10/2019
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