Provider Demographics
NPI:1518357169
Name:STEFANAC, PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:STEFANAC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2654
Mailing Address - Country:US
Mailing Address - Phone:906-226-0574
Mailing Address - Fax:888-347-1135
Practice Address - Street 1:1455 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2654
Practice Address - Country:US
Practice Address - Phone:906-226-0574
Practice Address - Fax:888-347-1135
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist