Provider Demographics
NPI:1982916581
Name:DERUY, STEPHANIE ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:DERUY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELIZABETH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11330 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-8100
Mailing Address - Country:US
Mailing Address - Phone:913-239-9539
Mailing Address - Fax:913-239-9893
Practice Address - Street 1:11330 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8100
Practice Address - Country:US
Practice Address - Phone:913-239-9539
Practice Address - Fax:913-239-9893
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04258225100000X
MO2011026845225100000X
IL070.017963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00931624OtherMEDICARE RAILROAD
IL212989015Medicare PIN
IL202845123Medicare PIN
ILP00867639OtherMEDICARE RAILROAD