Provider Demographics
NPI:1336390715
Name:MICHLIK, STEPHANIE M (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:MICHLIK
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 1:83 JENSEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2850
Mailing Address - Country:US
Mailing Address - Phone:732-476-8096
Mailing Address - Fax:732-923-1510
Practice Address - Street 1:901 W PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7271
Practice Address - Country:US
Practice Address - Phone:732-493-1166
Practice Address - Fax:732-923-1510
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011611002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics