Provider Demographics
NPI:1780107557
Name:TROSDAHL, SHELBY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:TROSDAHL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-0204
Mailing Address - Country:US
Mailing Address - Phone:218-282-0455
Mailing Address - Fax:
Practice Address - Street 1:105 GLEN HAVEN DR
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-4010
Practice Address - Country:US
Practice Address - Phone:218-282-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13506225100000X
MN225100000X
MN10743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist