MEDICARE: SUSAN STEFANELLI

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	225200000X	Physical Therapy Assistant	A0092	NV

General Provider Information

NPI Number	:	1588982268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN STEFANELLI

Provider Business Mailing Address
First Line	:	7324 W CHEYENNE AVE STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7426
Country	:	US
Telephone Number	:	702-214-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	7324 W CHEYENNE AVE STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7426
Country	:	US
Telephone Number	:	702-214-6665
Fax Number	:

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

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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Directions to “ SUSAN STEFANELLI ” Practice Location

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