=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770464729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESS COLETTE SCHAFFRIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 EAGLE CREEK LN STE 400
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55129-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-293-9294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 EAGLE CREEK LN
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55129-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-293-9294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1427479617
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------