Provider Demographics
NPI:1710435326
Name:DIMINO, STEPHANIE L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:DIMINO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BRACELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 SIMON ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3046
Mailing Address - Country:US
Mailing Address - Phone:603-417-3976
Mailing Address - Fax:603-589-1211
Practice Address - Street 1:39 SIMON ST STE 6
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3046
Practice Address - Country:US
Practice Address - Phone:603-417-3976
Practice Address - Fax:603-589-1211
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22577174400000X, 225100000X
NH4890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist