Provider Demographics
NPI:1497164578
Name:LINDBERG, KRISTIN (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 EVANS AVE NW
Mailing Address - Street 2:301
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 EVANS AVE NW
Practice Address - Street 2:301
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2696
Practice Address - Country:US
Practice Address - Phone:763-355-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer