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NPI 1700379120

NPI 1700379120 : MICHAEL SCHILLER : MINNETONKA, MN

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General NPI Number Information
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    NPI Number           |    1700379120
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    Entity Type          |    Individual 
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    Provider Name        |    MICHAEL SCHILLER
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    06/11/2018
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    Last Update Date     |    06/11/2018
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Provider Practice Location Address
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    Address Line         |    15000 MINNETONKA BLVD 
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    City                 |    MINNETONKA
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    State                |    MN
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    Zip                  |    55345-1506
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    Country              |    US
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    Telephone            |    952-935-4037
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    5655 W 35TH ST APT 216 
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    City                 |    ST LOUIS PARK
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    State                |    MN
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    Zip                  |    55416-5528
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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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       |    11092
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    License Number State |    MN
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