Provider Demographics
NPI:1528280112
Name:RAMBOUGH, AUDREY ANN (ATC,LAT)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:RAMBOUGH
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 WESTRAC DR.
Mailing Address - Street 2:#102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-400-7257
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NORTH DAKOTA, DIVISION OF SPORTS MEDICINE
Practice Address - Street 2:HYSLOP SPORTS CENTER ROOM 144, 2751 2ND AVE. N STOP9013
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-9013
Practice Address - Country:US
Practice Address - Phone:701-777-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND189-982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer