Provider Demographics
NPI:1164423356
Name:PEADEN, STEPHEN P (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:PEADEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 HIGHWAY 77 STE G
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5059
Mailing Address - Country:US
Mailing Address - Phone:850-248-0241
Mailing Address - Fax:850-248-0237
Practice Address - Street 1:3009 HIGHWAY 77 STE G
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5059
Practice Address - Country:US
Practice Address - Phone:850-248-0241
Practice Address - Fax:850-248-0237
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist