Provider Demographics
NPI:1801361720
Name:HATFIELD KALDAHL, SHANEL ELANE (PT)
Entity Type:Individual
Prefix:
First Name:SHANEL
Middle Name:ELANE
Last Name:HATFIELD KALDAHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHANEL
Other - Middle Name:ELANE
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4992 HERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 W SUPERIOR ST STE 112
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1885
Practice Address - Country:US
Practice Address - Phone:218-727-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2018-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist