MEDICARE: DR. SHELBY TROSDAHL PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	13506	AZ
2	225100000X	Physical Therapist		MN
3	225100000X	Physical Therapist	10743	MN

General Provider Information

NPI Number	:	1780107557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELBY TROSDAHL PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 204
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-0204
Country	:	US
Telephone Number	:	218-282-0455
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 GLEN HAVEN DR
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-4010
Country	:	US
Telephone Number	:	218-282-0455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	04/13/2022

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