Provider Demographics
NPI:1558748384
Name:FACCHINI, STEPHANIE (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FACCHINI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 OLD SANDWICH RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40928 HWY 6
Practice Address - Street 2:UNIT 2D
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657
Practice Address - Country:US
Practice Address - Phone:970-560-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer