Provider Demographics
NPI:1386672236
Name:PARTIS, STEPHANIE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:PARTIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:VANSLYKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:84 CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1517
Mailing Address - Country:US
Mailing Address - Phone:607-749-2219
Mailing Address - Fax:607-749-2286
Practice Address - Street 1:84 CORTLAND ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1517
Practice Address - Country:US
Practice Address - Phone:607-749-2219
Practice Address - Fax:607-749-2286
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025444-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000923581001OtherHEALTHNOW NY
NY364723OtherMVP
NY161303109OtherUNITED HEALTHCARE
NY000157471OtherBSCNY
NY5056028OtherAETNA
NY161303109OtherCIGNA