Provider Demographics
NPI:1124145875
Name:DOW, STEPHANIE PETTEGROW (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PETTEGROW
Last Name:DOW
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 1:220 HAPPYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2840
Mailing Address - Country:US
Mailing Address - Phone:207-664-0305
Mailing Address - Fax:
Practice Address - Street 1:57 WATER STREET
Practice Address - Street 2:BLUE HILL MEMORIAL HOSPITAL
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist