Individual
STEPHANIE EBERHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5310 MERCHANDISE DR, FORT WAYNE, IN 46825-5140
(260) 484-9491
Mailing address
12523 CANDLESET CV, FORT WAYNE, IN 46818-8783
(260) 348-2881
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06003225A
LICENSE #
IN
01
—
2306602144
LICENSE #
VA
Enumeration date
08/30/2006
Last updated
07/08/2007
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