Provider Demographics
NPI:1619195237
Name:BERTSCH, STEPHANI G (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:G
Last Name:BERTSCH
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 1:213 2ND AVE NE
Mailing Address - Street 2:PO BOX 759
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0759
Mailing Address - Country:US
Mailing Address - Phone:701-477-3161
Mailing Address - Fax:701-477-5564
Practice Address - Street 1:213 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-0759
Practice Address - Country:US
Practice Address - Phone:701-477-3161
Practice Address - Fax:701-477-5564
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1101OtherPHYSICAL THERAPIST