Provider Demographics
NPI:1063423945
Name:STOFAN, THERESA ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:STOFAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 N THESTA ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-449-9394
Mailing Address - Fax:559-449-8287
Practice Address - Street 1:6121 N THESTA ST
Practice Address - Street 2:SUITE 115
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8603
Practice Address - Country:US
Practice Address - Phone:559-449-9394
Practice Address - Fax:559-449-8287
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21079ZMedicare ID - Type Unspecified