Basic Information
| Provider Information | |||||||||
| NPI: | 1285968123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STENDER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26451 ROUGHRIDER RD NW | ||||||||
| Address2: | |||||||||
| City: | PINEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566764598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182432892 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | HWY 1 PHS INDIAN HOSPITAL | ||||||||
| Address2: | |||||||||
| City: | RED LAKE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566710497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186793912 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2009 | ||||||||
| LastUpdateDate: | 10/06/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 1275 | MN | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.