Physician Compare National (NPI:1104181650)

HEALTHCARE PROVIDER: STEFANIE DEPAUL PT, DPT, CSCS, RYT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104181650
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577711696
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120914000572
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROUSSELLE
	Individual professional last name
Provider First Name	STEFANIE
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	135 ELM ST
	Group Practice or individual's line 1 address
City	STONEHAM
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	021803427
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y