Provider Demographics
NPI:1780043240
Name:STONE, HEATHER M (MPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:STONE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 19TH ST S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4654
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:2300 24TH ST NW
Practice Address - Street 2:SUITE 101
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6379
Practice Address - Country:US
Practice Address - Phone:218-444-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist