Provider Demographics
NPI:1609852771
Name:MERWIN, STEPHANIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:MERWIN
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 1:24 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-629-1919
Mailing Address - Fax:413-629-1918
Practice Address - Street 1:24 PARK STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-629-1919
Practice Address - Fax:413-629-1918
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10056733OtherCDPHP
MA435803OtherMVP
MA0318540Medicaid
MA650022471OtherRAILROAD MEDICARE
MAMEY67687OtherBCBS OF MASSACHUSETTS
MAMEY67687OtherBCBS OF MASSACHUSETTS