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General NPI Number Information
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NPI Number | 1780939009
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Entity Type | Individual
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Provider Name | STEPHANIE PATRICIA BAZAL D.P.T., G.C.S.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 475 CHIPPEWA MALL DR 418
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-5034
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Country | US
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Telephone | 715-720-3086
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Fax |
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Provider Business Mailing Address
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Address Line | 1023 PINE CONE LN
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-8803
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Country | US
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Telephone | 715-222-8826
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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 | 8982
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License Number State | MN
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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 | 13250
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License Number State | WI
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