Provider Demographics
NPI:1881887958
Name:MOONEY, STEPHANIE ANDRIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANDRIS
Last Name:MOONEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANDRIS
Other - Last Name:RUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:364 PARK COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7703
Mailing Address - Country:US
Mailing Address - Phone:626-221-6075
Mailing Address - Fax:
Practice Address - Street 1:4000 CALLE TECATE STE 211
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5287
Practice Address - Country:US
Practice Address - Phone:626-221-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33757OtherSTATE LICENSE
CAAM967YMedicare PIN
CAAM967XMedicare PIN