Provider Demographics
NPI:1003509555
Name:STINEDURF, KAELEIGH SUZANNE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:KAELEIGH
Middle Name:SUZANNE
Last Name:STINEDURF
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2696
Mailing Address - Country:US
Mailing Address - Phone:978-735-4479
Mailing Address - Fax:978-735-4490
Practice Address - Street 1:1595 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2696
Practice Address - Country:US
Practice Address - Phone:978-735-4479
Practice Address - Fax:978-735-4490
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist