Healthcare Provider Details

I. General information

NPI: 1396576450
Provider Name (Legal Business Name): STEPHANIE VERONICA PETER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8358 MUNSON RD STE 105
MENTOR OH
44060-2452
US

IV. Provider business mailing address

8401 KIRTLAND CHARDON RD
KIRTLAND OH
44094-8607
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-2009
  • Fax:
Mailing address:
  • Phone: 440-478-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051789T
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021261
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: