Provider Demographics
NPI:1629323639
Name:TAYLOR, STEPHANIE ANNE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANNE
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9309 E RENO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3321
Mailing Address - Country:US
Mailing Address - Phone:405-732-3353
Mailing Address - Fax:405-732-3397
Practice Address - Street 1:9309 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3321
Practice Address - Country:US
Practice Address - Phone:405-732-3353
Practice Address - Fax:405-732-3397
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist