Basic Information
Provider Information
NPI: 1093955718
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STUMP
FirstName: DANA
MiddleName: I
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5300 DERRY ST
Address2: 2ND FL
City: HARRISBURG
State: PA
PostalCode: 171113576
CountryCode: US
TelephoneNumber: 7178392110
FaxNumber:  
Practice Location
Address1: 1805 LOUCKS RD
Address2: STE 200
City: YORK
State: PA
PostalCode: 174087902
CountryCode: US
TelephoneNumber: 7177640144
FaxNumber: 7177640554
Other Information
ProviderEnumerationDate: 02/21/2009
LastUpdateDate: 04/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT009262LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home