Provider Demographics
NPI:1285367821
Name:HEDBERG, EILEEN SHEA (PT, DPT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:SHEA
Last Name:HEDBERG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 IRVING AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5234
Mailing Address - Country:US
Mailing Address - Phone:612-710-3590
Mailing Address - Fax:
Practice Address - Street 1:1750 105TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4500
Practice Address - Country:US
Practice Address - Phone:763-780-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist