MR. CLINTON MCCULLOUGH (NPI# 1487030490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487030490 |
| Entity Type | Individual |
| Full Name | MR. CLINTON MCCULLOUGH |
| Credential | ATC |
| Practice Address |
435 Phalen Blvd Saint Paul MN 55130-5302 |
| Practice Telephone | 6512548368 |
| Practice Fax Number | 6512548361 |
| Mailing Telephone | 6512548368 |
| Mailing Fax Number | 6512548361 |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-08-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
2331 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
435 PHALEN BLVD |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55130-5302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740720812 | Nicole Renee Hoisser | Nurse Practitioner | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2017-03-08 |
| 1922548809 | Amy Jo Porter | Specialist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2017-02-27 |
| 1285186619 | Katherine Jonas | Physician Assistant | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-11-02 |
| 1316491970 | Angela Kezar | Occupational Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-08-11 |
| 1760833446 | Marie-pier Winters | Physical Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-06-24 |
| 1376904698 | Michaelen Elise Sundstrom | Physical Therapist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-03-14 |
| 1932568524 | Lindsay Knight | Specialist/Technologist | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2016-02-11 |
| 1134594310 | Dawn Babcock | Nurse Practitioner | 435 Phalen Blvd, Saint Paul, MN 55130-5302 | 2015-12-14 |
| 1750767158 | Leonardo E Candelario Perez | Psychologist | 435 Phalen Blvd, Saint Paul, MN 55130 | 2015-08-07 |
| 1912382193 | Melanie Richert | Nurse Practitioner | 435 Phalen Blvd, Ms51103b, Saint Paul, MN 55130-5302 | 2015-07-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904587 | Confident Care LLC | In Home Supportive Care | 1040 Arkwright Street, Saint Paul, MN 55130 | 2018-09-01 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1427394501 | Zongxee Lee | Registered Nurse | 1072 Payne Ave, St. Paul, MN 55130 | 2012-12-18 |
| 1740532753 | One Stop Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 1049 Payne Ave Suite C, St Paul, MN 55130 | 2012-10-15 |
| 1689923997 | Alexis Simmons | Counselor | 402 University Ave East, Suite A-127, Saint Paul, MN 55130 | 2012-08-31 |
| 1689804064 | Group Health Plan, Inc. | Durable Medical Equipment & Medical Supplies | 537 Phalen Blvd, Saint Paul, MN 55130 | 2009-07-21 |
| 1477756534 | Chad Everett Christensen | Chiropractor | 1073 Payne Ave, Saint Paul, MN 55130 | 2007-06-07 |
| 1922219021 | Qwik Urgent Care Clinic | Family Medicine | 1239 Payne Avenue, Saint Paul, MN 55130 | 2007-05-24 |
| 1275743981 | Yia Vang | Technician | 1100 Arkwright St., St. Paul, MN 55130 | 2007-05-23 |
| Find all providers in zip 55130 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598399206 | Titania Thao | Specialist/Technologist | 1160 Ross Ave, Saint Paul, MN 55106-3941 | 2020-03-03 |
| 1972168896 | Brett Michael Adelsman | Specialist/Technologist | 2118 Nebraska Ave E, Saint Paul, MN 55119-3052 | 2019-05-06 |
| 1740779057 | Jacob Christian Harle | Specialist/Technologist | 3900 Bethel Dr # Dr991, Saint Paul, MN 55112-6902 | 2018-05-02 |
| 1972004885 | Mackenzie Skipper | Specialist/Technologist | 13984 Ember Way, Saint Paul, MN 55124-9247 | 2018-02-26 |
| 1851768048 | Donelle Mcmahon | Specialist/Technologist | 2145 Ford Pkwy, Saint Paul, MN 55116-1900 | 2015-08-24 |
| 1033501887 | Erin Katharina Betts | Specialist/Technologist | 1130 Englewood Ave, Saint Paul, MN 55104-1410 | 2015-03-03 |
| 1942691969 | Natalie Erickson | Specialist/Technologist | 2344 Energy Park Dr, Saint Paul, MN 55108-1511 | 2015-02-12 |
| 1235576018 | Emily Jean Kidd | Specialist/Technologist | 2300 Doswell Ave, Saint Paul, MN 55108-1636 | 2013-06-03 |
| 1336425545 | Timothy Greve | Specialist/Technologist | 275 Syndicate St N, Saint Paul, MN 55104-5436 | 2011-11-01 |
| 1447373691 | Kristyn Joy Hubel | Specialist/Technologist | 360 Sherman St Ste 299, Saint Paul, MN 55102-2567 | 2007-04-10 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55130 |
Please comment or provide details below to improve the information on MR. CLINTON MCCULLOUGH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.