Provider Demographics
NPI:1326541376
Name:SMITH, STEPHANIE JOYCE (PTA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOYCE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13518 IMANI LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-1423
Mailing Address - Country:US
Mailing Address - Phone:825-549-5244
Mailing Address - Fax:
Practice Address - Street 1:7211 REGENCY SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3138
Practice Address - Country:US
Practice Address - Phone:713-244-9505
Practice Address - Fax:888-336-7050
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2041283225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant