Healthcare Provider Details

I. General information

NPI: 1023237377
Provider Name (Legal Business Name): STEPHANIE MARIE DUBERKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S ORLANDO AVE
WINTER PARK FL
32789-4867
US

IV. Provider business mailing address

10537 SATINWOOD CIR
ORLANDO FL
32825-8906
US

V. Phone/Fax

Practice location:
  • Phone: 407-691-7687
  • Fax:
Mailing address:
  • Phone: 407-282-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: