Provider Demographics
NPI:1770993214
Name:HILLESTAD, ANDREW H (ATC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:HILLESTAD
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 1:3110 E ROSSER AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5154
Mailing Address - Country:US
Mailing Address - Phone:701-425-4938
Mailing Address - Fax:
Practice Address - Street 1:3110 E ROSSER AVE APT 11
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5154
Practice Address - Country:US
Practice Address - Phone:701-425-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND488-122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer