Provider Demographics
NPI:1992767123
Name:WAY, STELLA THERESA (PT)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:THERESA
Last Name:WAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FINANCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1770
Mailing Address - Country:US
Mailing Address - Phone:864-437-8930
Mailing Address - Fax:864-437-8990
Practice Address - Street 1:10 FINANCIAL BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1770
Practice Address - Country:US
Practice Address - Phone:864-437-8930
Practice Address - Fax:864-437-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0065331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01358983Medicaid
NY53993BMedicare ID - Type Unspecified
NY01358983Medicaid