Basic Information
Provider Information | |||||||||
NPI: | 1427274034 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BJORNSTAD | ||||||||
FirstName: | EMILY | ||||||||
MiddleName: | JANE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 25 N HAMPSTEAD VILLAGE DR | ||||||||
Address2: |   | ||||||||
City: | HAMPSTEAD | ||||||||
State: | NC | ||||||||
PostalCode: | 284433932 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4013670190 | ||||||||
FaxNumber: | 4016193752 | ||||||||
Practice Location | |||||||||
Address1: | 1181 AQUIDNECK AVE | ||||||||
Address2: |   | ||||||||
City: | MIDDLETOWN | ||||||||
State: | RI | ||||||||
PostalCode: | 028425255 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4013670190 | ||||||||
FaxNumber: | 4016193752 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/18/2007 | ||||||||
LastUpdateDate: | 01/16/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | P15508 | NC | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
ID | Type | State | Issuer | Description | PT02699 | 01 | RI | PT LICENSE | OTHER | 070014217 | 01 | MA | LICENSE | OTHER |