Provider Demographics
NPI:1962579433
Name:PESSIN, STEPHANIE (PT, BA, BSPT, MPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PESSIN
Suffix:
Gender:F
Credentials:PT, BA, BSPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1819
Mailing Address - Country:US
Mailing Address - Phone:410-377-4287
Mailing Address - Fax:
Practice Address - Street 1:316 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1819
Practice Address - Country:US
Practice Address - Phone:443-838-4609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD183562251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty