Individual
IAN RODERICK MACPHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
4200 DAHLBERG DR STE 300, GOLDEN VALLEY, MN 55422-4841
(952) 512-5625
Mailing address
937 CROMWELL AVE, SAINT PAUL, MN 55114-1121
(651) 890-2342
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3160
MN
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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