Provider Demographics
NPI:1407323033
Name:FEEHAN, STEPHEN J (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:FEEHAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18077 RIVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8334
Mailing Address - Country:US
Mailing Address - Phone:317-776-7028
Mailing Address - Fax:317-773-7910
Practice Address - Street 1:18077 RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8334
Practice Address - Country:US
Practice Address - Phone:317-776-7028
Practice Address - Fax:317-773-7910
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014535A225100000X
MO2018039706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018039706OtherPHYSICAL THERAPY