Provider Demographics
NPI:1871933150
Name:ERNST, ANDREW (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ERNST
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14023 CHESTNUT DR
Mailing Address - Street 2:UNIT F
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1649
Mailing Address - Country:US
Mailing Address - Phone:920-858-8810
Mailing Address - Fax:
Practice Address - Street 1:16550 W 78TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-4315
Practice Address - Country:US
Practice Address - Phone:952-873-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer