Healthcare Provider Details

I. General information

NPI: 1306713037
Provider Name (Legal Business Name): STEPHANIE ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE JANE PENROD

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 ENSLEY CT
RICHMOND VA
23233-1850
US

IV. Provider business mailing address

11209 ENSLEY CT
RICHMOND VA
23233-1850
US

V. Phone/Fax

Practice location:
  • Phone: 804-241-7723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305204586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: