Provider Demographics
NPI:1538228952
Name:QUEEN, STEPHANIE MARIE (MPT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:QUEEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:765 RIVERSIDE DR APT 6L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7360
Mailing Address - Country:US
Mailing Address - Phone:212-568-0937
Mailing Address - Fax:212-568-0937
Practice Address - Street 1:765 RIVERSIDE DR APT 6L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7360
Practice Address - Country:US
Practice Address - Phone:212-568-0937
Practice Address - Fax:212-568-0937
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0139571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist