Provider Demographics
NPI:1730332297
Name:VANBRUNT, STEPHENIE MICHELLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:STEPHENIE
Middle Name:MICHELLE
Last Name:VANBRUNT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-1806
Mailing Address - Country:US
Mailing Address - Phone:609-835-1738
Mailing Address - Fax:
Practice Address - Street 1:208 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER PARK
Practice Address - State:NJ
Practice Address - Zip Code:08010-1806
Practice Address - Country:US
Practice Address - Phone:609-835-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00854000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist