Provider Demographics
NPI:1518549864
Name:BRIZEK, STEPHANIE MAE KARAVATAS (LPTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAE KARAVATAS
Last Name:BRIZEK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MAE
Other - Last Name:KARAVATAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:7406 ERSKA WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2002
Mailing Address - Country:US
Mailing Address - Phone:703-232-4211
Mailing Address - Fax:
Practice Address - Street 1:8525 ROLLING RD STE 320
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3673
Practice Address - Country:US
Practice Address - Phone:703-361-0465
Practice Address - Fax:571-535-4363
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant