Provider Demographics
NPI:1740538222
Name:HOUSE, STEPHANIE LAURA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAURA
Last Name:HOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 JEFFERSON CT STE 102
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9604
Practice Address - Country:US
Practice Address - Phone:540-832-3061
Practice Address - Fax:540-832-3062
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2024-11-27
Deactivation Date:2022-07-18
Deactivation Code:
Reactivation Date:2022-08-22
Provider Licenses
StateLicense IDTaxonomies
VA2305211674225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist