Provider Demographics
NPI:1730304205
Name:STEPHAN, JEAN E (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:STEPHAN
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:N3219 HIGHWAY H
Mailing Address - Street 2:STE 3
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1074
Mailing Address - Country:US
Mailing Address - Phone:262-248-9902
Mailing Address - Fax:
Practice Address - Street 1:N3219 HIGHWAY H
Practice Address - Street 2:STE 3
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1074
Practice Address - Country:US
Practice Address - Phone:262-248-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3209024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist