Provider Demographics
NPI:1699217505
Name:NEFSTEAD, ERIC (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:NEFSTEAD
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSAKIS
Mailing Address - State:MN
Mailing Address - Zip Code:56360-8243
Mailing Address - Country:US
Mailing Address - Phone:320-859-6217
Mailing Address - Fax:320-859-8114
Practice Address - Street 1:410 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OSAKIS
Practice Address - State:MN
Practice Address - Zip Code:56360-8243
Practice Address - Country:US
Practice Address - Phone:320-859-6217
Practice Address - Fax:320-859-8114
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist