Provider Demographics
NPI:1871610592
Name:FREWALDT, SHAWN ANNA (MSPT, ATP)
Entity type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:ANNA
Last Name:FREWALDT
Suffix:
Gender:F
Credentials:MSPT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25559 485TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARRETSON
Mailing Address - State:SD
Mailing Address - Zip Code:57030-6116
Mailing Address - Country:US
Mailing Address - Phone:605-594-2330
Mailing Address - Fax:
Practice Address - Street 1:1100 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6325
Practice Address - Country:US
Practice Address - Phone:605-782-2400
Practice Address - Fax:605-782-2401
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5834010Medicaid