Provider Demographics
NPI:1831757178
Name:STEM, JACQUELINE ANN
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:STEM
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 1:9 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1263
Mailing Address - Country:US
Mailing Address - Phone:215-301-0737
Mailing Address - Fax:
Practice Address - Street 1:205 E JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-2041
Practice Address - Country:US
Practice Address - Phone:610-275-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2019-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001920225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATEI001920OtherCOMMONWEALTH OF PA