Provider Demographics
NPI:1285295287
Name:ROSECRANS, STEPHANIE (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ROSECRANS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GRETHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:792 N MAIN ST STE 100C
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1667
Mailing Address - Country:US
Mailing Address - Phone:315-458-2552
Mailing Address - Fax:315-458-2575
Practice Address - Street 1:792 N MAIN ST STE 100C
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1667
Practice Address - Country:US
Practice Address - Phone:315-458-2552
Practice Address - Fax:315-458-2575
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist