Provider Demographics
NPI:1952733735
Name:STEFANOU, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:STEFANOU
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 1:2582 BLACK PINE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4102
Mailing Address - Country:US
Mailing Address - Phone:248-709-4596
Mailing Address - Fax:
Practice Address - Street 1:33089 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1501
Practice Address - Country:US
Practice Address - Phone:586-296-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist