Provider Demographics
NPI:1669558409
Name:MARKERT, STACY L (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:MARKERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:SOLBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:8455 FLYING CLOUD DR
Practice Address - Street 2:STE 100
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3974
Practice Address - Country:US
Practice Address - Phone:952-993-7470
Practice Address - Fax:952-993-7451
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist