Provider Demographics
NPI:1629080312
Name:STEPHAN, ERIKA JANE (PT)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:JANE
Last Name:STEPHAN
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 1:5388 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8218
Mailing Address - Country:US
Mailing Address - Phone:757-707-3955
Mailing Address - Fax:757-603-6231
Practice Address - Street 1:201 BULIFANTS BLVD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5731
Practice Address - Country:US
Practice Address - Phone:757-229-9740
Practice Address - Fax:757-229-9741
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3411029OtherAETNA PROVIDER#
VA200143785OtherTAX ID#
VA444255OtherMAMSI PROVIDER#
VA463830OtherANTHEM BCBS ID#
VA49827OtherOPTIMA PROVIDER#
VA444255OtherMAMSI PROVIDER#
VA200143785OtherTAX ID#