Provider Demographics
NPI:1124442447
Name:FELLOWS, STEPHANIE SUZANNE (PT, MSPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SUZANNE
Other - Last Name:SHINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:785 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8848
Mailing Address - Country:US
Mailing Address - Phone:614-893-1718
Mailing Address - Fax:
Practice Address - Street 1:380 ELM ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9220
Practice Address - Country:US
Practice Address - Phone:740-845-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.009852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist