Provider Demographics
NPI:1669846663
Name:TRYBUL, STEPHANIE (ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TRYBUL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 EBERLY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1848
Mailing Address - Country:US
Mailing Address - Phone:708-712-0948
Mailing Address - Fax:
Practice Address - Street 1:4205 EBERLY AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1848
Practice Address - Country:US
Practice Address - Phone:708-712-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0040642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer