Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2039 | SD |
N | 2251S0007X | Physical Therapist - Sports | 3771 | NE |
NPI | 1053763342 |
---|---|
Provider Name | Josie Renee Stockland |
First Address | Grand Rapids, MI 49546-7086 |
Second Address | Sioux Falls, SD 57104-4651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 31/10/2019 |