Healthcare Provider Details

I. General information

NPI: 1386134922
Provider Name (Legal Business Name): STEPHANIE FAERBER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHROME MISUMIMACHI
IWAKUNI YAMAGUCHI
7400025
JP

IV. Provider business mailing address

PSC 561 BOX 415
FPO AP
96310-0005
US

V. Phone/Fax

Practice location:
  • Phone: 70-253-3445
  • Fax:
Mailing address:
  • Phone: 785-643-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-05644
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: