Provider Demographics
NPI:1790198190
Name:SCHRAM, DENISE (PT/DPT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SCHRAM
Suffix:
Gender:F
Credentials:PT/DPT
Other - Prefix:
Other - First Name:DENIS
Other - Middle Name:
Other - Last Name:BODENSTEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4450 31ST AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4557
Mailing Address - Country:US
Mailing Address - Phone:701-451-9417
Mailing Address - Fax:701-298-0066
Practice Address - Street 1:4450 31ST AVE S STE 104
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4557
Practice Address - Country:US
Practice Address - Phone:701-451-9417
Practice Address - Fax:701-298-0066
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist