Basic Information
| Provider Information | |||||||||
| NPI: | 1871711945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPELKA | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | MELISSA | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2850 N COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857161910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203226274 | ||||||||
| FaxNumber: | 5205094496 | ||||||||
| Practice Location | |||||||||
| Address1: | 3988 E FORT LOWELL RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204885291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-014349 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 715177 | 05 | AZ | MEDICAID | 274404 | 05 | AZ | MEDICAID |