Healthcare Provider Details

I. General information

NPI: 1306809355
Provider Name (Legal Business Name): TREVOR JON ERLANDSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NICOLLET MALL SUITE 1935
MINNEAPOLIS MN
55402-2606
US

IV. Provider business mailing address

3250 W 66TH ST SUITE 120
EDINA MN
55435-2528
US

V. Phone/Fax

Practice location:
  • Phone: 612-339-2041
  • Fax: 612-339-2042
Mailing address:
  • Phone: 952-922-0330
  • Fax: 952-922-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6608
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: