Provider Demographics
NPI:1134599806
Name:SHEEHAN, STEPHANIE A (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HARTWELL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-3118
Mailing Address - Country:US
Mailing Address - Phone:781-879-7680
Mailing Address - Fax:781-274-1259
Practice Address - Street 1:110 HARTWELL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-3118
Practice Address - Country:US
Practice Address - Phone:781-879-7680
Practice Address - Fax:781-274-1259
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist