Provider Demographics
NPI:1174971832
Name:EGAN, STEPHANIE (PT, DPT, LMT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ROCKLAND RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4131
Mailing Address - Country:US
Mailing Address - Phone:815-893-8480
Mailing Address - Fax:815-893-8481
Practice Address - Street 1:530 ROCKLAND RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4131
Practice Address - Country:US
Practice Address - Phone:815-893-8480
Practice Address - Fax:815-893-8481
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist