Provider Demographics
NPI:1578526968
Name:DOLEZAL, SHANNON BECKER (MA, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BECKER
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:MA, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 15TH AVE S # 55
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2742
Mailing Address - Country:US
Mailing Address - Phone:706-206-2639
Mailing Address - Fax:
Practice Address - Street 1:3949 15TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2742
Practice Address - Country:US
Practice Address - Phone:706-206-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer