Provider Demographics
NPI:1457853970
Name:STEGALL, ALVIE THERAL
Entity Type:Individual
Prefix:
First Name:ALVIE
Middle Name:THERAL
Last Name:STEGALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STORM DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6748
Mailing Address - Country:US
Mailing Address - Phone:817-319-1938
Mailing Address - Fax:
Practice Address - Street 1:8745 SAN JOAQUIN TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7836
Practice Address - Country:US
Practice Address - Phone:817-319-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child