Provider Demographics
NPI:1194324251
Name:VADINO, STEPHANIE (PT,DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:VADINO
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 1:333 ROUTE 9 STE B-18
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1262
Mailing Address - Country:US
Mailing Address - Phone:732-269-1938
Mailing Address - Fax:
Practice Address - Street 1:333 ROUTE 9 STE B-18
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1262
Practice Address - Country:US
Practice Address - Phone:732-269-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2024-06-10
Deactivation Date:2024-05-22
Deactivation Code:
Reactivation Date:2024-06-10
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01956100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist