Provider Demographics
NPI:1407462310
Name:BIRD, STEPHANIE JOY (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOY
Last Name:BIRD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 KEITH LN
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-2190
Mailing Address - Country:US
Mailing Address - Phone:402-305-3803
Mailing Address - Fax:
Practice Address - Street 1:24711 AR-5
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:AR
Practice Address - Zip Code:72087
Practice Address - Country:US
Practice Address - Phone:501-922-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist