Most Relevant Information
Provider Data
| NPI Number: | 1003278813 |
| Provider Name: | BLAINE ANTHONY BIRTZER DAT, LAT, ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/22/2016 |
| Last Updated: | 12/21/2020 |
Provider Practice Location
1536 HEWITT AVE
SAINT PAUL
MN
551041284
Practice Location Phone/Fax
| Phone: | 6515233094 |
| Fax: |
Provider Mailing Location
1360 TERRACE DR APT 208
ROSEVILLE
MN
551131774
Provider Mailing Phone/Fax
| Phone: | 7152143898 |
| Fax: |