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NPI Code Detail

MEDICARE: MRS. STEPHANIE MARIE FOUTTY MPT, ATC

MEDICARE: MRS. STEPHANIE MARIE FOUTTY MPT, ATC
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
1225100000XPhysical TherapistPT002637WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164613782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE MARIE FOUTTY MPT, ATC
Provider Business Mailing Address
First Line : 1605 GRAND CENTRAL AVE
Second Line :
City : VIENNA
State : WV
Zip : 26105-1081
Country : US
Telephone Number : 304-295-7290
Fax Number : 304-295-5922
Provider Business Practice Location Address
First Line : 1605 GRAND CENTRAL AVE
Second Line :
City : VIENNA
State : WV
Zip : 26105-1081
Country : US
Telephone Number : 304-295-7290
Fax Number : 304-295-5922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2007
Last Update Date : 11/05/2022

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