Provider Demographics
NPI:1457951204
Name:ANDERSON, STEPHANIE SHARYN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SHARYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2204
Mailing Address - Country:US
Mailing Address - Phone:845-702-5269
Mailing Address - Fax:
Practice Address - Street 1:13 HAKIM ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5316
Practice Address - Country:US
Practice Address - Phone:203-744-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant