Provider Demographics
NPI:1174563894
Name:BEATTY-KOLLASCH, RONNI KAYE (ATC)
Entity type:Individual
Prefix:MRS
First Name:RONNI
Middle Name:KAYE
Last Name:BEATTY-KOLLASCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14969 77TH LN NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6921
Mailing Address - Country:US
Mailing Address - Phone:612-741-6007
Mailing Address - Fax:612-626-7748
Practice Address - Street 1:BIERMAN FIELD ATHLETIC BUILDING
Practice Address - Street 2:516 - 15TH AVENUE SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-5845
Practice Address - Fax:612-626-7748
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer