Provider Demographics
NPI:1619422565
Name:DEPAOL, STEPHEN LOUIS
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LOUIS
Last Name:DEPAOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MASTERS DR
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3527
Mailing Address - Country:US
Mailing Address - Phone:484-614-4743
Mailing Address - Fax:
Practice Address - Street 1:1100 SHILOH RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7522
Practice Address - Country:US
Practice Address - Phone:484-266-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002257A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer