MEDICARE: MS. CATHY LYNETTE STEPHENSON MS, PT, MSW

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	40QA01116600	NJ

General Provider Information

NPI Number	:	1326173089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHY LYNETTE STEPHENSON MS, PT, MSW

Provider Business Mailing Address
First Line	:	552 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1805
Country	:	US
Telephone Number	:	973-509-0827
Fax Number	:	973-509-0877

Provider Business Practice Location Address
First Line	:	552 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1805
Country	:	US
Telephone Number	:	973-509-0827
Fax Number	:	973-509-0877

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	01/07/2011

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