Provider Demographics
NPI:1164587911
Name:KULSTAD, SCOTT H (ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:H
Last Name:KULSTAD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13472 FOXBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2336
Mailing Address - Country:US
Mailing Address - Phone:612-802-1655
Mailing Address - Fax:
Practice Address - Street 1:13472 FOXBERRY RD
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2336
Practice Address - Country:US
Practice Address - Phone:612-802-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer