Provider Demographics
NPI:1154947760
Name:ARCHAMBAULT, STEPHANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ARCHAMBAULT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MCKINNEY AVE APT 366
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1694
Mailing Address - Country:US
Mailing Address - Phone:239-431-0258
Mailing Address - Fax:
Practice Address - Street 1:7417 MONIKA MANOR DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5814
Practice Address - Country:US
Practice Address - Phone:813-438-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1331576225100000X
FLPT41811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist