Provider Demographics
NPI:1972550663
Name:ALSUP, STEPHANIE (PT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:ALSUP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 N BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840
Mailing Address - Country:US
Mailing Address - Phone:830-774-1556
Mailing Address - Fax:830-774-6150
Practice Address - Street 1:1308 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-7818
Practice Address - Country:US
Practice Address - Phone:830-774-1556
Practice Address - Fax:830-774-6150
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1078137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00037844OtherRAILROAD MEDICARE NUMBER
TX108043403Medicaid
TX86878TOtherBLUE CROSS ID NUMBER
TX108043403Medicaid
TX86878TOtherBLUE CROSS ID NUMBER