Provider Demographics
NPI:1104379221
Name:HUSEBY, TAYLOR MARTIN (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARTIN
Last Name:HUSEBY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1357
Mailing Address - Country:US
Mailing Address - Phone:320-839-4090
Mailing Address - Fax:320-839-4196
Practice Address - Street 1:1420 E COLLEGE DR
Practice Address - Street 2:SUITE 704
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2065
Practice Address - Country:US
Practice Address - Phone:507-532-3393
Practice Address - Fax:507-532-3343
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist