Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502002448 | MI |
NPI | 1013505866 |
---|---|
Provider Name | Jason Edward Stefanski |
First Address | Dundee, MI 48131-8644 |
Second Address | Dundee, MI 48131-8644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2021 |
Last Update Date | 07/01/2021 |