Healthcare Provider Details

I. General information

NPI: 1417448531
Provider Name (Legal Business Name): STEPHANIE RESENDIZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 E GREENVILLE ST STE 119
ANDERSON SC
29621-1575
US

IV. Provider business mailing address

17 HILLCREST DR
DOWNINGTOWN PA
19335-1965
US

V. Phone/Fax

Practice location:
  • Phone: 864-964-0505
  • Fax: 864-222-0182
Mailing address:
  • Phone: 610-883-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: