Provider Demographics
NPI:1891040168
Name:RACICKI, STEPHANIE ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:RACICKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633448
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3448
Mailing Address - Country:US
Mailing Address - Phone:513-853-4749
Mailing Address - Fax:513-853-4740
Practice Address - Street 1:4030 SMITH RD
Practice Address - Street 2:SUITE 375
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1957
Practice Address - Country:US
Practice Address - Phone:513-221-4848
Practice Address - Fax:513-872-7828
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist