Individual
TYLER DANIEL SHAFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
310 SMITH AVE N STE 300, SAINT PAUL, MN 55102-2383
(952) 946-9777
Mailing address
18895 ENGLEWOOD WAY, FARMINGTON, MN 55024-8139
(651) 304-7725
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/20/2021
Last updated
11/27/2022
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