Provider Demographics
NPI:1578065181
Name:SPINK, STEPHANIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:SPINK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BEAUJEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2707 W JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2804
Mailing Address - Country:US
Mailing Address - Phone:734-692-5903
Mailing Address - Fax:734-692-7034
Practice Address - Street 1:2707 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2804
Practice Address - Country:US
Practice Address - Phone:734-692-5903
Practice Address - Fax:734-692-7034
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist