Provider Demographics
NPI:1467756197
Name:STELLA, BRENDA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:STELLA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49167 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1778
Mailing Address - Country:US
Mailing Address - Phone:586-873-1138
Mailing Address - Fax:
Practice Address - Street 1:49167 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1778
Practice Address - Country:US
Practice Address - Phone:586-873-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist