Active NPI
Brandon James Tetrault, ATC
- Athletic Trainer
- Grand Forks, ND
National Provider Identifier
1659671980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 953-22
- Practice address
- University of North Dakota
1301 N Columbia Rd
Grand Forks, ND 58202-0001 - Phone
- (701) 610-1060
- NPI assigned
- Nov 3, 2010
- Last updated
- Aug 15, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 953-22 | ND | Primary |
| Athletic Trainer | 2255A2300X | 2601001062 | MI |
Addresses
Primary practice location
University of North Dakota
1301 N Columbia Rd
Grand Forks, ND 58202-0001
Mailing address
University of North Dakota
1301 N Columbia Rd
Grand Forks, ND 58202
Phone (701) 610-1060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601001062 | MI | MD | Athletic Trainer |
| 953-22 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692057600000",
"number": "1659671980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "UNIVERSITY OF NORTH DAKOTA",
"address_2": "1301 N COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58202",
"telephone_number": "701-610-1060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "UNIVERSITY OF NORTH DAKOTA",
"address_2": "1301 N COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582020001",
"telephone_number": "701-610-1060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETRAULT",
"first_name": "BRANDON",
"middle_name": "JAMES",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-03",
"last_updated": "2023-08-15",
"certification_date": "2023-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "953-22",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601001062",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
- Talia Telander, MA, LPCC
- Marilyn Telles, RN
- Kevin J Temple, MD
- Neal Gary Tepper, LICSW
- Tamara Mary Ternes, PT
- Kathryn M. Tevington, M.D.
- Susan Rae Tharalson, RN
- The Aurora Cardiology Clinic
- The Housing Authority of the City of Grand Forks, North Dakota (Grand Forks Housing Authority)
- Theige Drug Inc (Medicap Pharmacy)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.