Provider Demographics
NPI:1700316494
Name:GOODWIN, STEPHANIE ELISE (PT, DPT, PRPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELISE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ELISE
Other - Last Name:VIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PRPC
Mailing Address - Street 1:622 WEST 168TH ST
Mailing Address - Street 2:SUITE #199
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-2720
Mailing Address - Fax:212-342-5708
Practice Address - Street 1:755 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1075
Practice Address - Country:US
Practice Address - Phone:914-366-3700
Practice Address - Fax:914-366-1312
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041614225100000X
CO0014730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist