Provider Demographics
NPI:1740514124
Name:OSBORN, STEPHANIE (DPT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17272 ROBBINS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:231-737-4374
Mailing Address - Fax:231-830-9196
Practice Address - Street 1:17272 ROBBINS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-256-8670
Practice Address - Fax:231-830-9196
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist