Provider Demographics
NPI:1891719191
Name:GROTH, AARON LAWRENCE (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:LAWRENCE
Last Name:GROTH
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 NEVADA AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3353
Mailing Address - Country:US
Mailing Address - Phone:763-226-8138
Mailing Address - Fax:763-780-0694
Practice Address - Street 1:1750 105TH AVE. NE
Practice Address - Street 2:SCHWAN CENTER
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449
Practice Address - Country:US
Practice Address - Phone:763-780-0356
Practice Address - Fax:763-780-0694
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040002080OtherNATA CERTIFICATION
MN1806OtherATHLETIC TRAINER RESGISTR