Healthcare Provider Details

I. General information

NPI: 1104379221
Provider Name (Legal Business Name): TAYLOR MARTIN HUSEBY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E COLLEGE DR SUITE 704
MARSHALL MN
56258-2065
US

IV. Provider business mailing address

100 LONDON RD
MARSHALL MN
56258-3070
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-3393
  • Fax: 507-532-3343
Mailing address:
  • Phone: 507-537-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9687
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: