Healthcare Provider Details

I. General information

NPI: 1285968123
Provider Name (Legal Business Name): JOHN WILLIAM STENDER PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 1 PHS INDIAN HOSPITAL
RED LAKE MN
56671-0497
US

IV. Provider business mailing address

26451 ROUGHRIDER RD NW
PINEWOOD MN
56676-4598
US

V. Phone/Fax

Practice location:
  • Phone: 218-679-3912
  • Fax:
Mailing address:
  • Phone: 218-243-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number1275
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: