Basic Information
| Provider Information | |||||||||
| NPI: | 1811355977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STENACK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CARL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 PROFESSIONAL VILLAGE CIR | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299071570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439869670 | ||||||||
| FaxNumber: | 8439869369 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 PROFESSIONAL VILLAGE CIR | ||||||||
| Address2: | |||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299071570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439869670 | ||||||||
| FaxNumber: | 8439869369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2016 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA003579 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.