Provider Demographics
NPI:1649222944
Name:MUNSON, STEPHANIE J (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:MUNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:11112 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5749
Practice Address - Country:US
Practice Address - Phone:253-537-1103
Practice Address - Fax:253-537-1087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8334039Medicaid
WA8923413OtherCRIME VICTIMS
WAMU5442OtherREGENCE BLUE SHIELD
WAA005OtherTRICARE
WA118318OtherDEPT OF LABOR & INDUSTRIE
WA8334039Medicaid