MEDICARE: MARY E STUPCZY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT011921	OH

General Provider Information

NPI Number	:	1467640201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E STUPCZY PT

Provider Business Mailing Address
First Line	:	12208 THRAVES AVE
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-4350
Country	:	US
Telephone Number	:	330-714-3592
Fax Number	:

Provider Business Practice Location Address
First Line	:	15900 SNOW RD
Second Line	:
City	:	BROOK PARK
State	:	OH
Zip	:	44142-2859
Country	:	US
Telephone Number	:	216-896-0824
Fax Number	:	216-896-0825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/05/2007

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Directions to “ MARY E STUPCZY PT” Practice Location

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