Provider Demographics
NPI:1316199664
Name:SANDERS, STEPHANIE LOUISE (MS, PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LOUISE
Other - Last Name:HINTZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942
Mailing Address - Country:US
Mailing Address - Phone:979-542-7300
Mailing Address - Fax:979-542-7373
Practice Address - Street 1:283 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942
Practice Address - Country:US
Practice Address - Phone:979-542-7300
Practice Address - Fax:979-542-7373
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1173110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist