Individual
MR. JUSTIN LEE SWAGGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
516 15TH AVE SE, MINNEAPOLIS, MN 55455-0130
(612) 625-0649
(612) 626-4789
Mailing address
2545 ALDRICH AVE S, MINNEAPOLIS, MN 55405-2925
(651) 334-9128
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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