Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 9889 | MN |
N | 225100000X | Physical Therapist | 3481 | NV |
Y | 2251X0800X | Physical Therapist - Orthopedic | 9889 | MN |
NPI | 1013301514 |
---|---|
Provider Name | Jesse Scheidecker |
First Address | Prior Lake, MN 55372-4800 |
Second Address | Prior Lake, MN 55372-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2015 |
Last Update Date | 12/02/2021 |