Provider Demographics
NPI:1275603755
Name:IRIZARRY, STEPHANIE MCCOY (PT CWS RMT MLT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MCCOY
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:PT CWS RMT MLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1199 S BELT LINE RD
Mailing Address - Street 2:# 140
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4666
Mailing Address - Country:US
Mailing Address - Phone:972-745-9060
Mailing Address - Fax:972-745-9069
Practice Address - Street 1:1199 S BELT LINE RD
Practice Address - Street 2:# 140
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4666
Practice Address - Country:US
Practice Address - Phone:972-745-9060
Practice Address - Fax:972-745-9069
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1094530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2846OtherBCBS ID
TX00171SMedicare ID - Type UnspecifiedMEDICARE GROUP ID
TX8T2846OtherBCBS ID
TXQ11447Medicare UPIN