Healthcare Provider Details

I. General information

NPI: 1932346509
Provider Name (Legal Business Name): SUSAN MARIE STELLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8266 ATLEE RD SUITE 133PT
MECHANICSVILLE VA
23116-1804
US

IV. Provider business mailing address

9210 ARBORETUM PKWY SUITE 260
RICHMOND VA
23236-3472
US

V. Phone/Fax

Practice location:
  • Phone: 804-569-1665
  • Fax: 804-569-1628
Mailing address:
  • Phone: 804-915-4602
  • Fax: 804-327-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305205690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: