Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shaun Douglass, PTA

Individual provider Physical Therapy Assistant · NPI 1265113450

Shaun Douglass, PTA is a Physical Therapy Assistant in Maple Grove, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.

Licensed in
MN
In the registry since
2023
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

7767 Elm Creek Blvd N Ste 160
Maple Grove, MN 55369-7078
Phone: (763) 201-8191
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence A1923 (MN)

Record details

NPI number1265113450
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorYes
NPI enumeratedJuly 31, 2023
Last updated in NPPESFebruary 4, 2025
Certification dateFebruary 4, 2025

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