Provider Demographics
NPI:1700145737
Name:GIORDANO, STEPHANIE A (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:GIORDANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4307 BALL CAMP PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3313
Mailing Address - Country:US
Mailing Address - Phone:865-524-1234
Mailing Address - Fax:865-524-2169
Practice Address - Street 1:4307 BALL CAMP PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921
Practice Address - Country:US
Practice Address - Phone:865-524-1234
Practice Address - Fax:865-524-2169
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525847Medicaid
TN103I655124Medicare PIN
TN1525847Medicaid
TN0677340004Medicare NSC
TN0677340005Medicare NSC
TN0677340010Medicare NSC
TN0677340001Medicare NSC
TN103I653668Medicare PIN