Provider Demographics
NPI:1891464459
Name:STERN, MICHAELA KATHERINE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:KATHERINE
Last Name:STERN
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 1:19 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3133
Mailing Address - Country:US
Mailing Address - Phone:401-338-2344
Mailing Address - Fax:
Practice Address - Street 1:OPT PHYSICAL THERAPY
Practice Address - Street 2:1181 AQUIDNECK AVENUE
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-845-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist