Provider Demographics
NPI:1568422244
Name:GILBERTSON, AMY (ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GILBERTSON
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 1:12944 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3503
Mailing Address - Country:US
Mailing Address - Phone:715-523-1626
Mailing Address - Fax:
Practice Address - Street 1:2115 SUMMIT AVE
Practice Address - Street 2:STE 5003
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1048
Practice Address - Country:US
Practice Address - Phone:952-300-0697
Practice Address - Fax:651-962-5981
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer