Provider Demographics
NPI:1487109807
Name:CHENG, STEFANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 S PARK VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6942
Mailing Address - Country:US
Mailing Address - Phone:213-282-8059
Mailing Address - Fax:408-351-0498
Practice Address - Street 1:1105 S PARK VICTORIA DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6942
Practice Address - Country:US
Practice Address - Phone:213-282-8059
Practice Address - Fax:408-351-0498
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist