MEDICARE: MRS. STEPHANIE A PARTIS PT

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	025444-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000923581001	OTHER	NY	HEALTHNOW NY
2	364723	OTHER	NY	MVP
3	161303109	OTHER	NY	UNITED HEALTHCARE
4	000157471	OTHER	NY	BSCNY
5	5056028	OTHER	NY	AETNA
6	161303109	OTHER	NY	CIGNA

General Provider Information

NPI Number	:	1386672236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE A PARTIS PT

Provider Business Mailing Address
First Line	:	84 CORTLAND ST
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-1517
Country	:	US
Telephone Number	:	607-749-2219
Fax Number	:	607-749-2286

Provider Business Practice Location Address
First Line	:	84 CORTLAND ST
Second Line	:
City	:	HOMER
State	:	NY
Zip	:	13077-1517
Country	:	US
Telephone Number	:	607-749-2219
Fax Number	:	607-749-2286

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	09/21/2021

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