Provider Demographics
NPI:1720053622
Name:TODARO, STEPHEN (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TODARO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 DOE RUN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2004 SPROUL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-359-1580
Practice Address - Fax:610-359-1050
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005857L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA084912NU9Medicare ID - Type Unspecified
PAQ27357Medicare UPIN