Provider Demographics
NPI:1528387073
Name:LONG, STEPHANIE DEE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DEE
Last Name:LONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 SWEDESBORO RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1800
Mailing Address - Country:US
Mailing Address - Phone:856-223-8898
Mailing Address - Fax:856-223-8799
Practice Address - Street 1:108 SWEDESBORO RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1800
Practice Address - Country:US
Practice Address - Phone:856-223-8898
Practice Address - Fax:856-223-8799
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01352700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist