Provider Demographics
NPI:1700357753
Name:CONSTAN, STEPHANIE (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CONSTAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 TERI TER
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3820
Mailing Address - Country:US
Mailing Address - Phone:517-303-5458
Mailing Address - Fax:
Practice Address - Street 1:2688 TERI TER
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3820
Practice Address - Country:US
Practice Address - Phone:517-303-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932142429Medicaid