1558816298 NPI number — BRITTANY STAMBAUGH PT

Table of content: BRITTANY STAMBAUGH PT (NPI 1558816298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558816298 NPI number — BRITTANY STAMBAUGH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAMBAUGH
Provider First Name:
BRITTANY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558816298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 COLLEGE AVE.
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-3384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-358-0800
Provider Business Mailing Address Fax Number:
717-358-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 COLLEGE AVE.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-3384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-358-0800
Provider Business Practice Location Address Fax Number:
717-358-0803
Provider Enumeration Date:
08/23/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT025341 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT025341 . This is a "LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".