Healthcare Provider Details

I. General information

NPI: 1861449019
Provider Name (Legal Business Name): SHAWN MARIE KRAUSE ROBERTS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 5TH ST N
BRECKENRIDGE MN
56520-1426
US

IV. Provider business mailing address

430 5TH ST N
BRECKENRIDGE MN
56520-1426
US

V. Phone/Fax

Practice location:
  • Phone: 218-641-7725
  • Fax: 218-641-6625
Mailing address:
  • Phone: 218-641-7725
  • Fax: 218-641-6625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6521
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: