Provider Demographics
NPI:1225887862
Name:KONONENKO, STEFANIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEFANIA
Middle Name:
Last Name:KONONENKO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 RODENE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4945
Mailing Address - Country:US
Mailing Address - Phone:805-368-0403
Mailing Address - Fax:
Practice Address - Street 1:5703 CORSA AVE STE 201
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4001
Practice Address - Country:US
Practice Address - Phone:805-750-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT305917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist