Provider Demographics
NPI:1235546136
Name:STANGEBYE, ALEXANDER OSMUND (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:OSMUND
Last Name:STANGEBYE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4001
Mailing Address - Country:US
Mailing Address - Phone:651-232-5412
Mailing Address - Fax:
Practice Address - Street 1:1309 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4104
Practice Address - Country:US
Practice Address - Phone:651-232-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist