1750893244 NPI number — STEPHANIE FELTIS MATTHEWS PT, DPT

Table of content: ANDREA MARY GOLLINGER LBA (NPI 1821708249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750893244 NPI number — STEPHANIE FELTIS MATTHEWS PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
STEPHANIE
Provider Middle Name:
FELTIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FELTIS
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
KRISTIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750893244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1904 N CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-5632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-271-4840
Provider Business Mailing Address Fax Number:
336-271-4941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1904 N CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-5632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-271-4840
Provider Business Practice Location Address Fax Number:
336-271-4941
Provider Enumeration Date:
10/25/2017

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:  P12003 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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