Provider Demographics
NPI:1538279286
Name:MAGNO, STEPHANIE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAGNO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13765 NW CORNELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5300
Mailing Address - Country:US
Mailing Address - Phone:503-724-1223
Mailing Address - Fax:
Practice Address - Street 1:13765 NW CORNELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5300
Practice Address - Country:US
Practice Address - Phone:503-724-1223
Practice Address - Fax:503-928-5615
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5134OtherOREGON PHYSICAL THERAPY BOARD