Provider Demographics
NPI:1609904093
Name:STEIN, DONNA ELLYN (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ELLYN
Last Name:STEIN
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 1:29229 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29229 JACKSON RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-1532
Practice Address - Country:US
Practice Address - Phone:216-233-6217
Practice Address - Fax:216-464-7163
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2219370Medicaid
OH199629OtherANTHEM PHYSICAL THERAPIST
OH199629OtherANTHEM PHYSICAL THERAPIST