Healthcare Provider Details

I. General information

NPI: 1083195895
Provider Name (Legal Business Name): STEPHANIE LAUREN VANSCHAICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LAUREN PEREZ DPT

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MEDFORD AVE
PATCHOGUE NY
11772-1281
US

IV. Provider business mailing address

712 MAIN ST
ISLIP NY
11751-3620
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-1910
  • Fax: 631-758-1984
Mailing address:
  • Phone: 631-666-3951
  • Fax: 631-666-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043431
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: