Provider Demographics
NPI:1104483585
Name:SFARA, STEPHANIE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SFARA
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 BROAD STREET RD
Mailing Address - Street 2:
Mailing Address - City:MAIDENS
Mailing Address - State:VA
Mailing Address - Zip Code:23102-2102
Mailing Address - Country:US
Mailing Address - Phone:330-360-0686
Mailing Address - Fax:
Practice Address - Street 1:6900 FOREST AVE STE 310
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1730
Practice Address - Country:US
Practice Address - Phone:330-360-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist