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General NPI Number Information
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NPI Number | 1356784045
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Entity Type | Individual
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Provider Name | STEPHANIE ANNE CAUDLE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 407 W 13TH ST SUITE 3B
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City | NEW YORK
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State | NY
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Zip | 10014-1112
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Country | US
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Telephone | 212-924-4920
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Fax |
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Provider Business Mailing Address
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Address Line | 523 GRAND ST APT 2
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City | NEW YORK
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State | NY
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Zip | 10002-4103
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Country | US
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Telephone | 336-366-9127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 036199
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6942
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License Number State | SC
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