Provider Demographics
NPI:1417685678
Name:STEARMAN, DESTINY TORI
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:TORI
Last Name:STEARMAN
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 1:2857 GUMM SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42782-7710
Mailing Address - Country:US
Mailing Address - Phone:270-405-6025
Mailing Address - Fax:
Practice Address - Street 1:213 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1166
Practice Address - Country:US
Practice Address - Phone:270-932-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist