Provider Demographics
NPI:1881693299
Name:BEAN, STEPHANIE KAY (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:BEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ELIOT CIR
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2576
Mailing Address - Country:US
Mailing Address - Phone:610-383-0331
Mailing Address - Fax:
Practice Address - Street 1:7465 LANCASTER PIKE
Practice Address - Street 2:BLDG 1
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9583
Practice Address - Country:US
Practice Address - Phone:302-234-4261
Practice Address - Fax:302-239-7306
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006755L225100000X
DEJ1-0002976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00716Medicare PIN
DE270419ZBSXMedicare PIN