Provider Demographics
NPI:1396576450
Name:PETER, STEPHANIE VERONICA (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VERONICA
Last Name:PETER
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 1:8401 KIRTLAND CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8607
Mailing Address - Country:US
Mailing Address - Phone:440-478-1038
Mailing Address - Fax:
Practice Address - Street 1:8358 MUNSON RD STE 105
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2452
Practice Address - Country:US
Practice Address - Phone:440-255-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT021261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist