Healthcare Provider Details

I. General information

NPI: 1154284495
Provider Name (Legal Business Name): JASELYN MCREAKEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 1ST DR NW
AUSTIN MN
55912-2941
US

IV. Provider business mailing address

1590 GRAY FOX DR NE
OWATONNA MN
55060-3975
US

V. Phone/Fax

Practice location:
  • Phone: 507-668-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13390
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: