Provider Demographics
NPI:1205238649
Name:STEFANEK, LILLIAN ELEANOR (PT)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:ELEANOR
Last Name:STEFANEK
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 1:2313 LASALLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1214
Mailing Address - Country:US
Mailing Address - Phone:610-670-7138
Mailing Address - Fax:
Practice Address - Street 1:125 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1808
Practice Address - Country:US
Practice Address - Phone:717-626-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005601L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist