Healthcare Provider Details

I. General information

NPI: 1790748044
Provider Name (Legal Business Name): KIMBERLY MARIE STUMPHAUZER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 WINCKLES ST
ELYRIA OH
44035
US

IV. Provider business mailing address

137 WINCKLES ST
ELYRIA OH
44035
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-5993
  • Fax: 440-366-5313
Mailing address:
  • Phone: 440-366-5993
  • Fax: 440-366-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT06051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: