Provider Demographics
NPI:1932244597
Name:FORD, STEPHANIE ELAINE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:FORD
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:JARNAGIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:402 W MARKET
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933
Mailing Address - Country:US
Mailing Address - Phone:765-362-6740
Mailing Address - Fax:765-362-6750
Practice Address - Street 1:402 W MARKET
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-362-6740
Practice Address - Fax:765-362-6750
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005923A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist