Provider Demographics
NPI:1215124730
Name:BRODE, STEPHANIE JEAN (DPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:BRODE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:310 PENN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2044
Mailing Address - Country:US
Mailing Address - Phone:814-695-2923
Mailing Address - Fax:814-965-8924
Practice Address - Street 1:4133 MEDICAL CENTER DR
Practice Address - Street 2:RT. 913
Practice Address - City:BROAD TOP
Practice Address - State:PA
Practice Address - Zip Code:16621-9001
Practice Address - Country:US
Practice Address - Phone:814-597-0028
Practice Address - Fax:814-597-0029
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT018961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist