Provider Demographics
NPI:1922412121
Name:BATDORF, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BATDORF
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 1:7584 IDA EAST RD
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9760
Mailing Address - Country:US
Mailing Address - Phone:419-360-4932
Mailing Address - Fax:
Practice Address - Street 1:7584 IDA EAST RD
Practice Address - Street 2:
Practice Address - City:IDA
Practice Address - State:MI
Practice Address - Zip Code:48140-9760
Practice Address - Country:US
Practice Address - Phone:419-360-4932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.07941225200000X
MI5502003176225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant