MEDICARE: MS. SUSAN MARIE STEPHEN P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00003672	WA

General Provider Information

NPI Number	:	1073648820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MARIE STEPHEN P.T.

Provider Business Mailing Address
First Line	:	PO BOX 65429
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98464-1429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7808 PACIFIC AVE STE 3
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98408-7039
Country	:	US
Telephone Number	:	253-471-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/24/2013

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