Provider Demographics
NPI:1366608283
Name:STAUB, STEPHANIE ANN (PTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:STAUB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350
Mailing Address - Country:US
Mailing Address - Phone:717-624-2161
Mailing Address - Fax:717-624-5453
Practice Address - Street 1:2290 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350
Practice Address - Country:US
Practice Address - Phone:717-624-2161
Practice Address - Fax:717-624-5453
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002593L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant