Provider Demographics
NPI:1184921587
Name:STEPANEK, CRISTAL M
Entity type:Individual
Prefix:
First Name:CRISTAL
Middle Name:M
Last Name:STEPANEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-7639
Mailing Address - Country:US
Mailing Address - Phone:815-985-9888
Mailing Address - Fax:
Practice Address - Street 1:3007 BAUER DR
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-7639
Practice Address - Country:US
Practice Address - Phone:815-985-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1199403225100000X
IL070014884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist