Provider Demographics
NPI:1144521568
Name:STEFANIAK, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STEFANIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY GRACE
Other - Middle Name:
Other - Last Name:TESTADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3290 N RIDGE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3657
Mailing Address - Country:US
Mailing Address - Phone:410-750-3090
Mailing Address - Fax:
Practice Address - Street 1:3290 N RIDGE RD STE 290
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3657
Practice Address - Country:US
Practice Address - Phone:410-750-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist