Provider Demographics
NPI:1508640749
Name:DIMIN, STEPHANIE ERIN (PTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ERIN
Last Name:DIMIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ERIN
Other - Last Name:RINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8900 W DOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1265
Mailing Address - Country:US
Mailing Address - Phone:414-805-6677
Mailing Address - Fax:
Practice Address - Street 1:8900 W DOYNE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1265
Practice Address - Country:US
Practice Address - Phone:414-805-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant