Provider Demographics
NPI:1174775597
Name:WACHOWICZ, STEPHANIE ANN (LPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:WACHOWICZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 OWLS NEST DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3827
Mailing Address - Country:US
Mailing Address - Phone:601-779-7122
Mailing Address - Fax:610-779-7122
Practice Address - Street 1:425 BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1101
Practice Address - Country:US
Practice Address - Phone:610-373-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005143L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist