Individual
JEFFREY DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT, ATC
Contact information
Practice address
11995 SINGLETREE LN STE 120, EDEN PRAIRIE, MN 55344-5338
(763) 220-6064
Mailing address
11995 SINGLETREE LN STE 120, EDEN PRAIRIE, MN 55344-5338
(763) 220-6064
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10977
MN
2255A2300X
Athletic Trainer
AL 4387
FL
Other
Enumeration date
04/06/2016
Last updated
03/08/2018
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