Healthcare Provider Details

I. General information

NPI: 1639304017
Provider Name (Legal Business Name): STEPHANIE N HERMIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE PARAVENTI

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ORCHARD LAKE RD STE 114
WEST BLOOMFIELD MI
48322-3424
US

IV. Provider business mailing address

6900 ORCHARD LAKE RD STE 114
WEST BLOOMFIELD MI
48322-3424
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-4480
  • Fax:
Mailing address:
  • Phone: 248-855-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501013736
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: