Provider Demographics
NPI:1225160153
Name:STREMICK, STEPHANIE RAE (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:STREMICK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:GIESEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4674 40TH AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4501
Mailing Address - Country:US
Mailing Address - Phone:701-293-7294
Mailing Address - Fax:701-282-9738
Practice Address - Street 1:4674 40TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-293-7294
Practice Address - Fax:701-282-9738
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6535225100000X
ND1286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist