Provider Demographics
NPI:1982786166
Name:BURNETT, STEPHANIE M (LPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:HANDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:6545 SPENCER CLARK RD
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:OH
Mailing Address - Zip Code:44418-9761
Mailing Address - Country:US
Mailing Address - Phone:330-772-0351
Mailing Address - Fax:
Practice Address - Street 1:609 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1750
Practice Address - Country:US
Practice Address - Phone:330-534-8500
Practice Address - Fax:330-534-3926
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT09681225100000X
PAPT020704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000216468OtherANTHEM
PA172775OtherMEDICARE PTAN
OH2344261Medicaid
OH34188311028OtherCARESOURCE
OH6497047OtherUHC
OH34177311027OtherCARESOURCE
OH34187731100OtherBWC
OH000000218075OtherANTHEM
OH34187731101OtherBWC
OH214507OtherHEALTH ASSURANCE
OH34177311027OtherCARESOURCE
P52233Medicare UPIN
650025423Medicare ID - Type Unspecified
OH34187731100OtherBWC