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General NPI Number Information
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NPI Number | 1780628529
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Entity Type | Organization
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Legal Business Name | STEVEN DISTEFANO PA
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4895 WINDWARD PASSAGE DR ST. #3
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-7741
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Country | US
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Telephone | 561-736-9899
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Fax | 561-736-2483
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Provider Business Mailing Address
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Address Line | 6749 LAS COLINAS ST
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City | LAKE WORTH
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State | FL
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Zip | 33463-6566
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Country | US
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Telephone | 561-641-4727
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Fax | 561-641-4455
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN ALEXANDER DISTEFANO
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Credential | PTA
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Telephone | 561-736-9899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA14688
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License Number State | FL
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