Provider Demographics
NPI:1326020025
Name:STELLRECHT, NANCY ANNE (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:STELLRECHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 14 3/4 AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8736
Mailing Address - Country:US
Mailing Address - Phone:715-859-6670
Mailing Address - Fax:715-859-6669
Practice Address - Street 1:2523 14 3/4 AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8736
Practice Address - Country:US
Practice Address - Phone:715-859-6670
Practice Address - Fax:715-859-6669
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2587-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40061700Medicaid
WI216L7STOtherATRIUM