Provider Demographics
NPI:1992295083
Name:STANLEY, PETER RICHARD (DPT)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:RICHARD
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 PARK GLEN RD APT 230
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4786
Mailing Address - Country:US
Mailing Address - Phone:763-843-6664
Mailing Address - Fax:
Practice Address - Street 1:444 N CORDOVA AVE
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-1704
Practice Address - Country:US
Practice Address - Phone:507-357-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist