Provider Demographics
NPI:1891039251
Name:SOUZA, STEPHANIE T (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:T
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-774 HUI ULILI ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4665
Mailing Address - Country:US
Mailing Address - Phone:808-722-1077
Mailing Address - Fax:
Practice Address - Street 1:47-774 HUI ULILI ST
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4665
Practice Address - Country:US
Practice Address - Phone:808-722-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant