Provider Demographics
NPI:1669785119
Name:SCHILLER, STEFANY M (LPT)
Entity type:Individual
Prefix:
First Name:STEFANY
Middle Name:M
Last Name:SCHILLER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:607 DEWEY AVE NW
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-7335
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:2740 E LANSING DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2898
Practice Address - Country:US
Practice Address - Phone:517-853-9139
Practice Address - Fax:517-853-9141
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501015288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP38270003Medicare PIN