Healthcare Provider Details

I. General information

NPI: 1982282919
Provider Name (Legal Business Name): STEPHANIE RENEE MAJCHRZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE RENEE MIRABELLA

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

IV. Provider business mailing address

13424 CARDINAL LN
CEDAR LAKE IN
46303-9466
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-1444
  • Fax: 219-926-6926
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005416A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: