Provider Demographics
NPI:1356784045
Name:CAUDLE, STEPHANIE ANNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:CAUDLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 GRAND ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4103
Mailing Address - Country:US
Mailing Address - Phone:336-366-9127
Mailing Address - Fax:
Practice Address - Street 1:407 W 13TH ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1112
Practice Address - Country:US
Practice Address - Phone:212-924-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036199225100000X
SC6942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist