Provider Demographics
NPI:1932346509
Name:STELLA, SUSAN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:STELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 ARBORETUM PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3472
Mailing Address - Country:US
Mailing Address - Phone:804-915-4602
Mailing Address - Fax:804-327-8496
Practice Address - Street 1:8266 ATLEE RD
Practice Address - Street 2:SUITE 133PT
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1804
Practice Address - Country:US
Practice Address - Phone:804-569-1665
Practice Address - Fax:804-569-1628
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052056902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932346509Medicaid
VA0472640012Medicare NSC
VAMC12695Medicare PIN
VA0472640004Medicare NSC
VA0472640005Medicare NSC