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General NPI Number Information
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NPI Number | 1467640201
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Entity Type | Individual
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Provider Name | MARY E STUPCZY PT
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Gender | Female
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 15900 SNOW RD
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City | BROOK PARK
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State | OH
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Zip | 44142-2859
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Country | US
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Telephone | 216-896-0824
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Fax | 216-896-0825
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Provider Business Mailing Address
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Address Line | 12208 THRAVES AVE
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City | GARFIELD HTS
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State | OH
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Zip | 44125-4350
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Country | US
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Telephone | 330-714-3592
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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 | PT011921
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License Number State | OH
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