Provider Demographics
NPI:1386958569
Name:EMMINGS, STEFANIE L (MT)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:L
Last Name:EMMINGS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HAMEL RD
Mailing Address - Street 2:P O BOX 271
Mailing Address - City:HAMEL
Mailing Address - State:MN
Mailing Address - Zip Code:55340-4567
Mailing Address - Country:US
Mailing Address - Phone:763-478-3978
Mailing Address - Fax:763-478-3502
Practice Address - Street 1:75 HAMEL RD
Practice Address - Street 2:
Practice Address - City:HAMEL
Practice Address - State:MN
Practice Address - Zip Code:55340-4567
Practice Address - Country:US
Practice Address - Phone:763-478-3978
Practice Address - Fax:763-478-3502
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist