Provider Demographics
NPI:1639405723
Name:STAGEBERG, JUANITA C (PT)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:C
Last Name:STAGEBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JUANITA
Other - Middle Name:L
Other - Last Name:COLBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:201 HOSPITAL RD.
Mailing Address - Street 2:EAGLE RIVER MEMORIAL HOSPITAL
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521-8835
Mailing Address - Country:US
Mailing Address - Phone:715-479-0224
Mailing Address - Fax:715-479-0398
Practice Address - Street 1:201 HOSPITAL RD.
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54521-8835
Practice Address - Country:US
Practice Address - Phone:715-479-0224
Practice Address - Fax:715-479-0398
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4403-24225100000X
ND1526225100000X
MN7392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist