Provider Demographics
NPI:1225256597
Name:STEFUT, BETSY A. ANN (PTA)
Entity Type:Individual
Prefix:
First Name:BETSY A.
Middle Name:ANN
Last Name:STEFUT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 FAIRWIND DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1379
Mailing Address - Country:US
Mailing Address - Phone:513-708-1624
Mailing Address - Fax:
Practice Address - Street 1:5640 COX SMITH RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2210
Practice Address - Country:US
Practice Address - Phone:513-398-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01234225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant