Individual
LORI E STEFANCIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008011A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000834464
ANTHEM PROVIDER NUMBER
IN
05
—
201189140
—
IN
Enumeration date
08/14/2013
Last updated
08/18/2017
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