Healthcare Provider Details

I. General information

NPI: 1972754331
Provider Name (Legal Business Name): MRS. TANYA ROSE STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 WINDMILL RD
SINKING SPRING PA
19608-1614
US

IV. Provider business mailing address

3000 WINDMILL RD
SINKING SPRING PA
19608-1614
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-2100
  • Fax:
Mailing address:
  • Phone: 610-670-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE005873L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: