Provider Demographics
NPI:1912024969
Name:PARR, STEPHANIE ANN (MPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:PARR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:ARCHIBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:101 W 92 HWY
Practice Address - Street 2:STE H
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7590
Practice Address - Country:US
Practice Address - Phone:816-903-0777
Practice Address - Fax:816-903-0776
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ578320Medicaid