Provider Demographics
NPI:1356216436
Name:HOLMGREN, STACY
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4616
Mailing Address - Country:US
Mailing Address - Phone:308-225-1870
Mailing Address - Fax:888-908-5481
Practice Address - Street 1:211 W 38TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4616
Practice Address - Country:US
Practice Address - Phone:308-225-1870
Practice Address - Fax:888-908-5481
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty