MEDICARE: MRS. STEPHANIE S CONLOW 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	6058	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2Z0451	OTHER	AZ	HEALTH NET
2	AZ0460540	OTHER	AZ	BLUECROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558377572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE S CONLOW PT

Provider Business Mailing Address
First Line	:	16405 WHITTIER BLVD
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-3044
Country	:	US
Telephone Number	:	714-823-4400
Fax Number	:	714-823-4404

Provider Business Practice Location Address
First Line	:	12572 VALLEY VIEW ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2006
Country	:	US
Telephone Number	:	714-823-4400
Fax Number	:	714-823-4404

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/25/2023

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