Individual
SHAUN DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
7767 ELM CREEK BLVD N STE 160, MAPLE GROVE, MN 55369-7078
(763) 201-8191
Mailing address
6145 MACLYNN AVE NE, OTSEGO, MN 55301-4589
(763) 213-5505
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A1923
MN
Other
Enumeration date
07/31/2023
Last updated
02/04/2025
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