Provider Demographics
NPI:1801187638
Name:NEUBAUER, STEPHANIE R
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 MONROE ST APT B
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-1965
Mailing Address - Country:US
Mailing Address - Phone:406-672-1387
Mailing Address - Fax:
Practice Address - Street 1:1707 OAK STREET
Practice Address - Street 2:SUITE D ABSAROKA PAIN AND REHAB
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-587-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant