Provider Demographics
NPI:1861449019
Name:KRAUSE ROBERTS, SHAWN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:MARIE
Last Name:KRAUSE ROBERTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1426
Mailing Address - Country:US
Mailing Address - Phone:218-641-7725
Mailing Address - Fax:218-641-6625
Practice Address - Street 1:430 5TH ST N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1426
Practice Address - Country:US
Practice Address - Phone:218-641-7725
Practice Address - Fax:218-641-6625
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6521225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23126OtherNDBCBS FOR USE AT MN SITE
MN96570OtherHEALTH PARTNERS
MN057K9KROtherBCBS
MN101592300OtherUS DEPT OF LABOR
ND1458831Medicaid
MN1041486OtherPREFERRED ONE
MN64-04035OtherMEDICA FOR MN SITE
MN03N45KROtherMNBCBS FOR USE AT ND SITE
ND23126OtherNDBCBS FOR USE AT MN SITE
MN96570OtherHEALTH PARTNERS
ND54542Medicaid
MN96570OtherHEALTH PARTNERS