Provider Demographics
NPI:1255524088
Name:GIRARD, STEPHANIE L (DPT)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:L
Last Name:GIRARD
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 1:743 MAIN ST
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2707
Mailing Address - Country:US
Mailing Address - Phone:617-970-5362
Mailing Address - Fax:
Practice Address - Street 1:743 MAIN ST
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2707
Practice Address - Country:US
Practice Address - Phone:617-970-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17016225100000X
RI1912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist