Provider Demographics
NPI:1689259541
Name:SHINGLE CREEK PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SHINGLE CREEK PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:STADTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-515-8799
Mailing Address - Street 1:2781 FREEWAY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1765
Mailing Address - Country:US
Mailing Address - Phone:763-515-8799
Mailing Address - Fax:763-244-8021
Practice Address - Street 1:2781 FREEWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-1765
Practice Address - Country:US
Practice Address - Phone:763-515-8799
Practice Address - Fax:763-244-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty