Healthcare Provider Details

I. General information

NPI: 1518368604
Provider Name (Legal Business Name): ANGELA STEFANONI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1998 ROUTE 70 E
CHERRY HILL NJ
08003-1834
US

IV. Provider business mailing address

25 VIRGINIA TRL
MEDFORD NJ
08055-9028
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-2000
  • Fax:
Mailing address:
  • Phone: 609-351-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01564800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: