Active NPI
Trevor Weidt
- Athletic Trainer
- East Bethel, MN
National Provider Identifier
1770356909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 333 217TH Ave NE
East Bethel, MN 55011-9124 - Phone
- (612) 695-2301
- NPI assigned
- Oct 31, 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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MN | ||
| Athletic Trainer | 2255A2300X | MN | Primary |
Addresses
Primary practice location
333 217TH Ave NE
East Bethel, MN 55011-9124
Mailing address
333 217TH Ave NE
East Bethel, MN 55011-9124
Phone (612) 695-2301
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698710400000",
"number": "1770356909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 217TH AVE NE",
"city": "EAST BETHEL",
"state": "MN",
"postal_code": "550119124",
"telephone_number": "612-695-2301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 217TH AVE NE",
"city": "EAST BETHEL",
"state": "MN",
"postal_code": "550119124",
"telephone_number": "612-695-2301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEIDT",
"first_name": "TREVOR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-31",
"last_updated": "2023-10-31",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MN",
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Bethel, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.