Healthcare Provider Details

I. General information

NPI: 1205250628
Provider Name (Legal Business Name): JOHN SHELDAHL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT STREET SOUTH 2 ROOM 236
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

205 W WACKER DR SUITE 1020
CHICAGO IL
60606-1216
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6228
  • Fax: 515-241-8685
Mailing address:
  • Phone: 312-640-0329
  • Fax: 312-640-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: