Provider Demographics
NPI:1225222458
Name:BATES, STEPHANIE ANN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 E OSBORN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7146
Mailing Address - Country:US
Mailing Address - Phone:602-265-4124
Mailing Address - Fax:
Practice Address - Street 1:1641 E OSBORN RD
Practice Address - Street 2:STE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7146
Practice Address - Country:US
Practice Address - Phone:602-265-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77582251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics