Provider Demographics
NPI:1992849962
Name:ERLANDSON, STEPHANIE BERNICE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BERNICE
Last Name:ERLANDSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:BERNICE
Other - Last Name:SCHRACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:332 N MONTOUR ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-1832
Mailing Address - Country:US
Mailing Address - Phone:570-368-2518
Mailing Address - Fax:
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-320-7456
Practice Address - Fax:570-320-7455
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer