Provider Demographics
NPI:1073147864
Name:SYPERT, STEPHANIE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SYPERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12569 COUNTY ROAD 2803
Mailing Address - Street 2:
Mailing Address - City:EUSTACE
Mailing Address - State:TX
Mailing Address - Zip Code:75124-3920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12569 COUNTY ROAD 2803
Practice Address - Street 2:
Practice Address - City:EUSTACE
Practice Address - State:TX
Practice Address - Zip Code:75124-3920
Practice Address - Country:US
Practice Address - Phone:512-787-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist