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Individual

MR. ETHAN ROBERTS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
1916 HAUGHTON AVE APT 1, NORTH MANKATO, MN 56003-1440
(507) 995-7937
Mailing address
1916 HAUGHTON AVE APT 1, NORTH MANKATO, MN 56003-1440

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
D834044851615
MN

Other

Enumeration date
07/03/2014
Last updated
07/03/2014
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