Provider Demographics
NPI:1073007530
Name:STEJBACH, ELLEN ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROSE
Last Name:STEJBACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 DELTA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1178
Mailing Address - Country:US
Mailing Address - Phone:513-321-8484
Mailing Address - Fax:513-321-3676
Practice Address - Street 1:455 DELTA AVE STE 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1178
Practice Address - Country:US
Practice Address - Phone:513-321-8484
Practice Address - Fax:513-321-3676
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist