Provider Demographics
NPI:1487799276
Name:SJOSTEDT, SIMON
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:SJOSTEDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 GREEN ACRES RD STE 11
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1715
Mailing Address - Country:US
Mailing Address - Phone:541-654-0274
Mailing Address - Fax:541-228-9121
Practice Address - Street 1:1020 GREEN ACRES RD STE 11
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1715
Practice Address - Country:US
Practice Address - Phone:541-654-0274
Practice Address - Fax:541-228-9121
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21818225100000X
NC10719225100000X
ME3033225100000X
CA33509225100000X
OR64368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist