Provider Demographics
NPI:1457695777
Name:TEOLIS, STEPHANIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:TEOLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:STRUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN AVE.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:N. CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-3610
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:710-2 CLAIRTON BLVD.
Practice Address - Street 2:K-MART PLAZA
Practice Address - City:PLEASANT HILLS
Practice Address - State:PA
Practice Address - Zip Code:15236-4596
Practice Address - Country:US
Practice Address - Phone:412-655-4252
Practice Address - Fax:412-655-4253
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027788180001Medicaid