Basic Information
| Provider Information | |||||||||
| NPI: | 1205251188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDOUGAL | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | LANSDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194465211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158559871 | ||||||||
| FaxNumber: | 2158558748 | ||||||||
| Practice Location | |||||||||
| Address1: | 594 E BROAD ST | ||||||||
| Address2: | |||||||||
| City: | SOUDERTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189641200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673820433 | ||||||||
| FaxNumber: | 2673820323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2014 | ||||||||
| LastUpdateDate: | 03/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT023375 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.