Provider Demographics
NPI:1942439906
Name:STEALY, BECKY RENEE (DPT)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:RENEE
Last Name:STEALY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:RENEE
Other - Last Name:SATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4200 DAHLBERG DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4841
Mailing Address - Country:US
Mailing Address - Phone:763-520-7870
Mailing Address - Fax:763-520-7580
Practice Address - Street 1:4100 MINNESOTA DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-456-7000
Practice Address - Fax:952-456-7001
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare PIN