Provider Demographics
NPI:1780668715
Name:STOKES, STEPHEN R (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:STOKES
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5066
Mailing Address - Country:US
Mailing Address - Phone:518-869-6220
Mailing Address - Fax:518-869-6465
Practice Address - Street 1:1971 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5066
Practice Address - Country:US
Practice Address - Phone:518-869-6220
Practice Address - Fax:518-869-6465
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
58880013OtherBCDC
64674301OtherBSMD
3986683OtherAETNA
MD674MM609Medicare ID - Type Unspecified