MEDICARE: MRS. STEPHANIE PANTALEO DPT

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

General Provider Information

NPI Number	:	1275932675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE PANTALEO DPT

Provider Business Mailing Address
First Line	:	PO BOX 64207
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85728-4207
Country	:	US
Telephone Number	:	520-829-7712
Fax Number	:	520-314-3141

Provider Business Practice Location Address
First Line	:	3305 N SWAN RD STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1273
Country	:	US
Telephone Number	:	520-321-0204
Fax Number	:	520-321-0495

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	05/05/2021

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