Individual
NICHOLAS DEPHILLIPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ST, SA
Contact information
Practice address
2700 VIKINGS CIR, EAGAN, MN 55121
(952) 456-7600
Mailing address
4200 DAHLBERG DR STE 300, GOLDEN VALLEY, MN 55422-4841
(763) 520-7870
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3236
MN
Other
Enumeration date
07/28/2014
Last updated
06/05/2019
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