Provider Demographics
NPI:1972878189
Name:STELLA'S REHABILITATION WELLNESS PT PC
Entity Type:Organization
Organization Name:STELLA'S REHABILITATION WELLNESS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DVORIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-871-0390
Mailing Address - Street 1:7508 AVENUE T FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6207
Mailing Address - Country:US
Mailing Address - Phone:718-781-0390
Mailing Address - Fax:
Practice Address - Street 1:3044 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5660
Practice Address - Country:US
Practice Address - Phone:718-781-0390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty