Provider Demographics
NPI:1902935976
Name:AREND, STEPHANIE LYN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYN
Last Name:AREND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 ROAD 60
Mailing Address - Street 2:
Mailing Address - City:HAVILAND
Mailing Address - State:OH
Mailing Address - Zip Code:45851-9620
Mailing Address - Country:US
Mailing Address - Phone:419-238-0715
Mailing Address - Fax:
Practice Address - Street 1:835 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1064
Practice Address - Country:US
Practice Address - Phone:419-399-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT06772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2412348Medicaid