Provider Demographics
NPI:1184828394
Name:GADD, STEPHANIE LOUISE (PTA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:GADD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:LOUISE
Other - Last Name:NORTHCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7326 ST RT 19
Mailing Address - Street 2:UNIT 2514
Mailing Address - City:MT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338
Mailing Address - Country:US
Mailing Address - Phone:419-946-1457
Mailing Address - Fax:
Practice Address - Street 1:50 BLYMYER AVE
Practice Address - Street 2:MANSFIELD MEMORIAL HOMES
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903
Practice Address - Country:US
Practice Address - Phone:419-774-5100
Practice Address - Fax:419-756-1267
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA02771225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant