MEDICARE: SHANDI HALVORSON

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1891416855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANDI HALVORSON

Provider Business Mailing Address
First Line	:	15574 EDGEWOOD DR
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56401-6955
Country	:	US
Telephone Number	:	218-829-2665
Fax Number	:

Provider Business Practice Location Address
First Line	:	15574 EDGEWOOD DR STE 102
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56401-6956
Country	:	US
Telephone Number	:	218-829-2665
Fax Number	:

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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Directions to “ SHANDI HALVORSON ” Practice Location

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