Provider Demographics
NPI:1194741900
Name:SMITH, STEPHANIE SCIARRA (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SCIARRA
Last Name:SMITH
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 1:1920 BARNEY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-4337
Mailing Address - Country:US
Mailing Address - Phone:530-365-2142
Mailing Address - Fax:530-365-5655
Practice Address - Street 1:1920 BARNEY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-4337
Practice Address - Country:US
Practice Address - Phone:530-365-2142
Practice Address - Fax:530-365-5655
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24040ZOtherMEDICARE GROUP
CA0PT267540Medicare ID - Type Unspecified
0PT267540Medicare PIN