Provider Demographics
NPI:1710275755
Name:CALABRESE, STEVIE LYNN
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:LYNN
Last Name:CALABRESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEVIE
Other - Middle Name:
Other - Last Name:DORBAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1086 HIGHWAY 315 BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7012
Mailing Address - Country:US
Mailing Address - Phone:570-823-7761
Mailing Address - Fax:570-822-8033
Practice Address - Street 1:1086 HIGHWAY 315 BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7012
Practice Address - Country:US
Practice Address - Phone:570-823-7761
Practice Address - Fax:570-829-7761
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 021443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist