Healthcare Provider Details

I. General information

NPI: 1962498238
Provider Name (Legal Business Name): SHAWNA L HULZEBOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SHAWNA L RUCKLE PT

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 ROWE AVE
WORTHINGTON MN
56187-9700
US

IV. Provider business mailing address

1720 S CLIFF AVE
SIOUX FALLS SD
57105-2129
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-2232
  • Fax: 605-332-5327
Mailing address:
  • Phone: 605-334-5630
  • Fax: 605-332-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6816
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: