Provider Demographics
NPI:1922844091
Name:PINKSTON, STEFAN
Entity type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1974
Mailing Address - Country:US
Mailing Address - Phone:570-800-3347
Mailing Address - Fax:
Practice Address - Street 1:2489 ROUTE 6 STE 6
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-6144
Practice Address - Country:US
Practice Address - Phone:570-218-7909
Practice Address - Fax:570-390-7901
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist