Basic Information
| Provider Information | |||||||||
| NPI: | 1699291575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARAVELLO | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | THERESE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1243 WOODROW RD STE 321 | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103091725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188445350 | ||||||||
| FaxNumber: | 7189660005 | ||||||||
| Practice Location | |||||||||
| Address1: | 9920 4TH AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112098379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182389873 | ||||||||
| FaxNumber: | 7182389754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 08/22/2017 | ||||||||
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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 | 041911 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.