Provider Demographics
NPI:1639353386
Name:STONER, REBECCA SUE (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:STONER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0325
Mailing Address - Country:US
Mailing Address - Phone:218-387-9494
Mailing Address - Fax:218-387-3584
Practice Address - Street 1:101 W HIGHWAY 61 STE 130
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-2333
Practice Address - Country:US
Practice Address - Phone:218-387-9494
Practice Address - Fax:218-387-3584
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650002039Medicare PIN