Provider Demographics
NPI:1821745472
Name:MEJIA, STEFANI (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8141 KILWINNING LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5517
Mailing Address - Country:US
Mailing Address - Phone:904-504-2499
Mailing Address - Fax:
Practice Address - Street 1:2140 KINGSLEY AVE STE 5
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-272-2830
Practice Address - Fax:904-272-8814
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38398208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38398OtherLICENSE