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General NPI Number Information
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NPI Number | 1962609743
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Entity Type | Individual
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Provider Name | STEPHANIE RENEE KORFANTA REILLY DPT
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 3405 172ND ST NE STE 10
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City | ARLINGTON
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State | WA
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Zip | 98223-7717
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Country | US
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Telephone | 360-651-8880
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Fax | 360-651-9975
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Provider Business Mailing Address
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Address Line | 27500 102ND AVE NW STE 1
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City | STANWOOD
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State | WA
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Zip | 98292-8092
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Country | US
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Telephone | 360-629-7528
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Fax | 360-629-7632
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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 | PT00010596
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License Number State | WA
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