Provider Demographics
NPI:1780830208
Name:PEDERSON, STEVEN L (DPT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:PEDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HIGHWAY 2 W STE 7
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2913
Mailing Address - Country:US
Mailing Address - Phone:701-662-8448
Mailing Address - Fax:
Practice Address - Street 1:210 HIGHWAY 2 W STE 7
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2913
Practice Address - Country:US
Practice Address - Phone:701-662-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist