Provider Demographics
NPI:1649380544
Name:RICHARDS, STEPHANIE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:RICHARDS
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 1:2416 CONSTITUTION AVENUE
Mailing Address - Street 2:REHABILITATION TODAY
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-2808
Mailing Address - Fax:716-372-2902
Practice Address - Street 1:2416 CONSTITUTION AVENUE
Practice Address - Street 2:REHABILITATION TODAY
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-2808
Practice Address - Fax:716-372-2902
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025887225100000X
PAPT017841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00283258OtherRAILROAD MEDICARE
NY0247092Medicaid
Q12350Medicare UPIN
NYRA1394Medicare ID - Type Unspecified