Provider Demographics
NPI:1427274034
Name:BJORNSTAD, EMILY JANE (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:BJORNSTAD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N HAMPSTEAD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3932
Mailing Address - Country:US
Mailing Address - Phone:401-367-0190
Mailing Address - Fax:401-619-3752
Practice Address - Street 1:1181 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5255
Practice Address - Country:US
Practice Address - Phone:401-367-0190
Practice Address - Fax:401-619-3752
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP155082251X0800X
MA070014217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPT02699OtherPT LICENSE
MA070014217OtherLICENSE