Provider Demographics
NPI:1649435405
Name:HALASA, STEPHANIE ROSE (PT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROSE
Last Name:HALASA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:ROSE
Other - Last Name:ZIEMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:28 JADEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-2704
Mailing Address - Country:US
Mailing Address - Phone:215-946-1684
Mailing Address - Fax:
Practice Address - Street 1:1480 OXFORD VALLEY RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5630
Practice Address - Country:US
Practice Address - Phone:215-321-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013558L225100000X
NJ40QA01148400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist