Individual
MR. SHANE ALLEN MESCHKE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
9549 PENN AVE S, BLOOMINGTON, MN 55431-2563
(952) 888-9549
(952) 703-3481
Mailing address
13716 ALABAMA AVE S, SAVAGE, MN 55378-2460
(612) 987-5913
(952) 703-3481
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2033422
AMERICA'S PPO
MN
01
—
394M2ME
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/27/2005
Last updated
07/08/2007
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