Provider Demographics
NPI:1306809355
Name:ERLANDSON, TREVOR JON (PT)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:JON
Last Name:ERLANDSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W 66TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2528
Mailing Address - Country:US
Mailing Address - Phone:952-922-0330
Mailing Address - Fax:952-922-0990
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 1935
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-339-2041
Practice Address - Fax:612-339-2042
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6402379OtherMEDICA INDIV PROV ID
MN28F05EROtherBC INDIV PROV ID