Provider Demographics
NPI:1376024489
Name:ABBEY, STEPHANIE JOYCE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOYCE
Last Name:ABBEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 STATE HIGHWAY 154 W APT 2
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:TX
Mailing Address - Zip Code:75755-3691
Mailing Address - Country:US
Mailing Address - Phone:501-581-9943
Mailing Address - Fax:
Practice Address - Street 1:502 E COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3416
Practice Address - Country:US
Practice Address - Phone:903-342-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2133660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant