Provider Demographics
NPI:1376152181
Name:DIGIACOMO, STEVIE MARIE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:STEVIE
Middle Name:MARIE
Last Name:DIGIACOMO
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:MISS
Other - First Name:STEVIE
Other - Middle Name:MARIE
Other - Last Name:OLIVARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACT, LAT
Mailing Address - Street 1:316 E HUFF AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2235
Mailing Address - Country:US
Mailing Address - Phone:954-448-5895
Mailing Address - Fax:
Practice Address - Street 1:7611 MARBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1691
Practice Address - Country:US
Practice Address - Phone:210-397-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT65552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT6555OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION