Individual
MR. CLINTON MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
435 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(651) 254-8368
(651) 254-8361
Mailing address
435 PHALEN BLVD, SAINT PAUL, MN 55130-5302
(651) 254-8368
(651) 254-8361
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2331
MN
Other
Enumeration date
08/03/2015
Last updated
08/03/2015
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