Provider Demographics
NPI:1952849291
Name:FEIZ-MAHDAVI, STEPHANIE SHEREEN (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHEREEN
Last Name:FEIZ-MAHDAVI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 SAN FELIPE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1776
Mailing Address - Country:US
Mailing Address - Phone:713-270-5900
Mailing Address - Fax:713-270-5910
Practice Address - Street 1:7575 SAN FELIPE ST STE 125
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1776
Practice Address - Country:US
Practice Address - Phone:713-270-5900
Practice Address - Fax:713-270-5910
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12865092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369242801Medicaid