Provider Demographics
NPI:1346591393
Name:GAINES, STEPHANIE BETH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BETH
Last Name:GAINES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:998 HOSPITALITY WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1762
Mailing Address - Country:US
Mailing Address - Phone:410-273-9776
Mailing Address - Fax:410-273-9777
Practice Address - Street 1:998 HOSPITALITY WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-1762
Practice Address - Country:US
Practice Address - Phone:410-273-9776
Practice Address - Fax:410-273-9777
Is Sole Proprietor?:No
Enumeration Date:2012-09-29
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207364225100000X
MD19114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist