Provider Demographics
NPI:1467982835
Name:HARTMAN, STEPHANIE JUELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUELLE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JUELLE
Other - Last Name:SPINDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17566 SW YEAGER LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1891
Mailing Address - Country:US
Mailing Address - Phone:408-859-1465
Mailing Address - Fax:
Practice Address - Street 1:9370 SW GREENBURG RD STE B
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5408
Practice Address - Country:US
Practice Address - Phone:503-295-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR195135OtherMEDICARE
OR500726708Medicaid