Provider Demographics
NPI:1528711975
Name:STIENNON, SEAN THOMAS MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS MICHAEL
Last Name:STIENNON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S POLK AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2832
Mailing Address - Country:US
Mailing Address - Phone:608-279-9763
Mailing Address - Fax:
Practice Address - Street 1:302 2ND ST NE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3412
Practice Address - Country:US
Practice Address - Phone:641-424-1740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist