Individual
STEPHANIE W CISNEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
14603 SW TEAL BLVD, BEAVERTON, OR 97007-6194
(971) 709-7193
(503) 567-2732
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(503) 567-2732
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
7438
AZ
225100000X
Physical Therapist
Primary
—
—
2251H1200X
Hand Physical Therapist
PT60839924
WA
2251X0800X
Orthopedic Physical Therapist
7438
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5550830001
MEDICARE NSC SCW
AZ
01
—
5550830003
MEDICARE NSC PEORIA
AZ
01
—
5550830004
MEDICARE NSC PV
AZ
01
—
5550830006
MEDICARE NSC ANTHEM
AZ
01
—
5550830007
MEDICARE NSC DV
AZ
01
—
5550830008
MEDICARE NSC SWV
AZ
01
—
5550830009
MEDICARE NSC AZ NORTH
AZ
01
—
5550830010
MEDICARE NSC GILBERT
AZ
Enumeration date
10/19/2006
Last updated
12/12/2023
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