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General NPI Number Information
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NPI Number | 1548719826
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Entity Type | Individual
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Provider Name | DANIELLE SHETKA DPT
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Gender | Female
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 618 DIVISION ST S SUITE 103
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City | NORTHFIELD
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State | MN
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Zip | 55057-2487
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Country | US
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Telephone | 507-645-8325
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Fax | 507-645-8953
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Provider Business Mailing Address
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Address Line | PO BOX 756
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City | NORTHFIELD
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State | MN
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Zip | 55057-0756
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Country | US
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Telephone | 507-645-8325
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Fax | 507-645-8953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10447
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License Number State | MN
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