Healthcare Provider Details

I. General information

NPI: 1528899259
Provider Name (Legal Business Name): STEPHANIE EFENECY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 FETTLER PARK DR
DUMFRIES VA
22025-2049
US

IV. Provider business mailing address

3695 FETTLER PARK DR
DUMFRIES VA
22025-2049
US

V. Phone/Fax

Practice location:
  • Phone: 571-427-4378
  • Fax: 571-833-4378
Mailing address:
  • Phone: 571-427-4378
  • Fax: 571-833-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305216670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: