Healthcare Provider Details

I. General information

NPI: 1578621421
Provider Name (Legal Business Name): MARIAN BERYL STEIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 KEMP RD E
GREENSBORO NC
27410-5634
US

IV. Provider business mailing address

118 KEMP RD E
GREENSBORO NC
27410-5634
US

V. Phone/Fax

Practice location:
  • Phone: 336-707-4880
  • Fax:
Mailing address:
  • Phone: 336-707-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: