Basic Information
| Provider Information | |||||||||
| NPI: | 1952733735 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STEFANOU | ||||||||
| FirstName: | LEAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2582 BLACK PINE TRAIL DR | ||||||||
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| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480984102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487094596 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33089 GROESBECK HWY | ||||||||
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| City: | FRASER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480261501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862962800 | ||||||||
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| ProviderEnumerationDate: | 08/05/2013 | ||||||||
| LastUpdateDate: | 08/05/2013 | ||||||||
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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 | 5501016379 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.