Provider Demographics
NPI:1215069158
Name:GARDNER, SHAWN M (MYOTHERAPIST)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:M
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MYOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 MINNETONKA MILLS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5100
Mailing Address - Country:US
Mailing Address - Phone:952-933-3000
Mailing Address - Fax:
Practice Address - Street 1:11300 MINNETONKA MILLS RD
Practice Address - Street 2:SUITE C
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5100
Practice Address - Country:US
Practice Address - Phone:952-933-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist