Provider Demographics
NPI:1831648922
Name:BRANCHAUD, STEPHANIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BRANCHAUD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 GROVE CIR N STE 100
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2682
Mailing Address - Country:US
Mailing Address - Phone:763-302-4114
Mailing Address - Fax:
Practice Address - Street 1:9645 GROVE CIR N STE 100
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-2682
Practice Address - Country:US
Practice Address - Phone:763-302-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist