Provider Demographics
NPI:1447762232
Name:WASNIEWSKI, STEPHANIE J (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:WASNIEWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:230 GRANT RD STE B27
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-7715
Mailing Address - Country:US
Mailing Address - Phone:509-884-1437
Mailing Address - Fax:509-884-2811
Practice Address - Street 1:230 GRANT RD STE B27
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7715
Practice Address - Country:US
Practice Address - Phone:509-884-1437
Practice Address - Fax:509-884-2811
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60763112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0382665OtherWA STATE LABOR AND INDUSTRIES
WA2090347Medicaid