Provider Demographics
NPI:1720034564
Name:STERN, DEENA JOELLE (LPT)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:JOELLE
Last Name:STERN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:JOELLE
Other - Last Name:BRISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13609
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-3609
Mailing Address - Country:US
Mailing Address - Phone:252-636-9800
Mailing Address - Fax:252-636-1945
Practice Address - Street 1:1202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2405
Practice Address - Country:US
Practice Address - Phone:252-447-4005
Practice Address - Fax:252-447-4001
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078GKOtherBCBS
NC7211171Medicaid
NC7211171Medicaid