Individual
CARLY P PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC/R
Contact information
Practice address
18929 149TH ST NW, ELK RIVER, MN 55330-8362
(612) 518-7270
Mailing address
516 15TH AVE SE, ROOM 190, MINNEAPOLIS, MN 55455-0130
(612) 518-7270
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2433
MN
Other
Enumeration date
06/03/2013
Last updated
04/29/2021
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