Provider Demographics
NPI:1164624359
Name:MORRIS, STEPHANIE ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:BLOOMFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:7930 S EMERSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8626
Practice Address - Country:US
Practice Address - Phone:317-859-5857
Practice Address - Fax:317-865-2265
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172308225100000X
IN05009875A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05009875Medicaid
INM400055696Medicare PIN