Provider Demographics
NPI:1891074662
Name:BERRY, STEFANIE C (DPT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:C
Last Name:BERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:C
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:333 N FOXRIDGE DR
Mailing Address - Street 2:APT 104
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7829
Mailing Address - Country:US
Mailing Address - Phone:816-225-8067
Mailing Address - Fax:
Practice Address - Street 1:294 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-554-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist