Provider Demographics
NPI:1184331753
Name:ZARECZNY, STEPHANIE (ATC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ZARECZNY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CHAMPIONS WAY # 168
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7543
Mailing Address - Country:US
Mailing Address - Phone:414-369-9433
Mailing Address - Fax:
Practice Address - Street 1:168 CHAMPIONS WAY # 168
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7543
Practice Address - Country:US
Practice Address - Phone:414-369-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL41102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer