Individual
STACI M THEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
158 19TH ST S, SARTELL, MN 56377-2153
(320) 253-5385
Mailing address
512 ELENA LN, SAINT JOSEPH, MN 56374-4596
(612) 219-4492
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1287
MN
Other
Enumeration date
11/07/2011
Last updated
11/07/2011
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