Provider Demographics
NPI:1962609743
Name:REILLY, STEPHANIE RENEE KORFANTA (DPT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RENEE KORFANTA
Last Name:REILLY
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:27500 102ND AVE NW
Mailing Address - Street 2:STE 1
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-7528
Mailing Address - Fax:360-629-7632
Practice Address - Street 1:3405 172ND ST NE
Practice Address - Street 2:STE 10
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7717
Practice Address - Country:US
Practice Address - Phone:360-651-8880
Practice Address - Fax:360-651-9975
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2014-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00010596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8866939Medicare PIN