Provider Demographics
NPI:1386680544
Name:WASKO, STEPHANIE ALLISON (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:WASKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ALLISON
Other - Last Name:LOUDAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3707 GAZELLE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9291
Mailing Address - Country:US
Mailing Address - Phone:713-906-1029
Mailing Address - Fax:
Practice Address - Street 1:2637 LAZY BEND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-1006
Practice Address - Country:US
Practice Address - Phone:281-485-4144
Practice Address - Fax:281-485-4196
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5347Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #