Provider Demographics
NPI:1770952558
Name:AHRENS, STEPHANIE (ATC,LAT,DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:AHRENS
Suffix:
Gender:F
Credentials:ATC,LAT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N9379 PINE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-9240
Mailing Address - Country:US
Mailing Address - Phone:715-453-5797
Mailing Address - Fax:
Practice Address - Street 1:1509 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2107
Practice Address - Country:US
Practice Address - Phone:715-459-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15460-24225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist