Healthcare Provider Details

I. General information

NPI: 1396803250
Provider Name (Legal Business Name): STELLARCARE,PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 BETHLEHEM PIKE SUITE 210
ERDENHEIM PA
19038-8111
US

IV. Provider business mailing address

717 BETHLEHEM PIKE SUITE 210
ERDENHEIM PA
19038-8111
US

V. Phone/Fax

Practice location:
  • Phone: 267-285-0067
  • Fax: 267-285-0069
Mailing address:
  • Phone: 267-285-0067
  • Fax: 267-285-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007003L
License Number StatePA

VIII. Authorized Official

Name: MISS DEBORAH SHORE
Title or Position: PRESIDENT
Credential: P.T.
Phone: 267-285-0067