Provider Demographics
NPI:1285968123
Name:STENDER, JOHN WILLIAM (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:STENDER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26451 ROUGHRIDER RD NW
Mailing Address - Street 2:
Mailing Address - City:PINEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56676-4598
Mailing Address - Country:US
Mailing Address - Phone:218-243-2892
Mailing Address - Fax:
Practice Address - Street 1:HWY 1 PHS INDIAN HOSPITAL
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0497
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1275282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240206Medicare Oscar/Certification
MNHSZ009Medicare PIN