Provider Demographics
NPI:1760432033
Name:KRINER, STEPHEN EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:KRINER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1893
Mailing Address - Country:US
Mailing Address - Phone:814-827-0354
Mailing Address - Fax:814-827-0352
Practice Address - Street 1:228 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1893
Practice Address - Country:US
Practice Address - Phone:814-827-0354
Practice Address - Fax:814-827-0352
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008466L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA443704OtherHIGHMARK BC/BS NUMBER
PA0014779150001Medicaid
PA443704OtherHIGHMARK BC/BS NUMBER
PA025766M6PMedicare ID - Type UnspecifiedMEDICARE I.D. NUMBER