Provider Demographics
NPI:1376783803
Name:PURCELL, STEPHANIE ANN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANN
Last Name:PURCELL
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 1:1114 E HORSEHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6014
Mailing Address - Country:US
Mailing Address - Phone:208-284-2016
Mailing Address - Fax:
Practice Address - Street 1:401 CHEYENNE
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-8748
Practice Address - Country:US
Practice Address - Phone:620-649-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-428225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant