Healthcare Provider Details

I. General information

NPI: 1710655329
Provider Name (Legal Business Name): STEPHANIE MCDONOUGH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 FORREST AVE STE 101
DOVER DE
19904-3483
US

IV. Provider business mailing address

336 BROAD ST # 203
ROME GA
30161-3006
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-4900
  • Fax:
Mailing address:
  • Phone: 407-880-8438
  • Fax: 407-880-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37476
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0014871
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: