Mitchell Willert
Individual provider Active NPI Athletic Trainer · Lolo, MT
NPI 1184166126 · NPPES record last updated Jul 19, 2024
Key facts
- NPI
- 1184166126
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 5510 Bison LN
Lolo, MT 59847-9757 - Phone
- (608) 287-4077
- NPI assigned
- Nov 8, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
5510 Bison LN
Lolo, MT 59847-9757
Mailing address
1830 Essex Dr
Sun Prairie, WI 53590-3517
Other providers in Lolo, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.