Provider Demographics
NPI: | 1184712234 |
---|---|
Name: | CHRISTEN, SHEILA M (PT) |
Entity type: | Individual |
Prefix: | |
First Name: | SHEILA |
Middle Name: | M |
Last Name: | CHRISTEN |
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: | 1812 TYLER PATH |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT CLOUD |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 56301-7512 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 320-654-8086 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1521 NORTHWAY DR |
Practice Address - Street 2: | SUITE #116 |
Practice Address - City: | SAINT CLOUD |
Practice Address - State: | MN |
Practice Address - Zip Code: | 56303-4489 |
Practice Address - Country: | US |
Practice Address - Phone: | 320-654-9838 |
Practice Address - Fax: | 320-654-0981 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-11 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 5667 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 64-05608 | Other | MEDICA AND SELECT CARE |
MN | 351G4SW | Other | BLUE CROSS BLUE SHIELD |
MN | P00234581 | Other | RAILROAD MEDICARE |
MN | HP42620 | Other | HEALTH PARTNERS |