Provider Demographics
NPI:1902029671
Name:MODELL, CURT WILLIAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:CURT
Middle Name:WILLIAM
Last Name:MODELL
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 1:14385 CORMORANT WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-7113
Mailing Address - Country:US
Mailing Address - Phone:651-423-4662
Mailing Address - Fax:
Practice Address - Street 1:1440 DUCKWOOD DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1451
Practice Address - Country:US
Practice Address - Phone:651-688-7857
Practice Address - Fax:651-688-7855
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1635247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other