Provider Demographics
NPI:1083801195
Name:DUGGAN, STEPHANIE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CATLIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2012
Mailing Address - Country:US
Mailing Address - Phone:763-682-2202
Mailing Address - Fax:763-682-2439
Practice Address - Street 1:300 CATLIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2012
Practice Address - Country:US
Practice Address - Phone:763-682-2202
Practice Address - Fax:763-682-2439
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist