Healthcare Provider Details

I. General information

NPI: 1023326113
Provider Name (Legal Business Name): STEPHANIE LAYNE PFORTMILLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S ASH ST
STOCKTON KS
67669-2136
US

IV. Provider business mailing address

315 S ASH ST
STOCKTON KS
67669-2136
US

V. Phone/Fax

Practice location:
  • Phone: 785-425-7129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-02012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: