Provider Demographics
NPI:1780681395
Name:DUERINGER, STEPHANIE LEIGH (MSPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:DUERINGER
Suffix:
Gender:
Credentials:MSPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:TRUSCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:803-812-3656
Mailing Address - Fax:
Practice Address - Street 1:14765 HAZEL DELL XING STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7046
Practice Address - Country:US
Practice Address - Phone:317-218-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007356A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200467570Medicaid