Provider Demographics
NPI:1508143439
Name:STEFANCIN, CRAIG BRADLEY (MPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:BRADLEY
Last Name:STEFANCIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 W BRUCETON RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4237
Mailing Address - Country:US
Mailing Address - Phone:412-650-9998
Mailing Address - Fax:412-650-9998
Practice Address - Street 1:257 W BRUCETON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4237
Practice Address - Country:US
Practice Address - Phone:412-650-9998
Practice Address - Fax:412-650-9998
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-012042-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist