Provider Demographics
NPI:1417998857
Name:MERKLE, STEPHEN (MS PT OCS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MERKLE
Suffix:
Gender:M
Credentials:MS PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4129
Mailing Address - Country:US
Mailing Address - Phone:203-778-8326
Mailing Address - Fax:203-792-9170
Practice Address - Street 1:22 EAGLE RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4129
Practice Address - Country:US
Practice Address - Phone:203-778-8326
Practice Address - Fax:203-792-9170
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT513491OtherAETNA
CT06140156402OtherUHC
CTD400001010Medicare PIN