Provider Demographics
NPI:1013309749
Name:TRITT, STEPHANY (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:
Last Name:TRITT
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 1:1158 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1403
Mailing Address - Country:US
Mailing Address - Phone:323-314-3415
Mailing Address - Fax:323-982-9018
Practice Address - Street 1:1158 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1403
Practice Address - Country:US
Practice Address - Phone:323-314-3415
Practice Address - Fax:323-982-9018
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27050OtherPT LICENSE