Provider Demographics
NPI:1790252492
Name:STADHEIM, EMILY ANN (LAT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:STADHEIM
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:BREMSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:MN
Mailing Address - Zip Code:56009-0099
Mailing Address - Country:US
Mailing Address - Phone:507-402-2947
Mailing Address - Fax:507-874-2747
Practice Address - Street 1:215 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:MN
Practice Address - Zip Code:56009-8700
Practice Address - Country:US
Practice Address - Phone:507-402-2947
Practice Address - Fax:507-874-2747
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer