Provider Demographics
NPI:1134891849
Name:HUTCHESON, STELLA ELLEN (PTA)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:ELLEN
Last Name:HUTCHESON
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 1:1700 GA HIGHWAY 203
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-2622
Mailing Address - Country:US
Mailing Address - Phone:912-269-4597
Mailing Address - Fax:
Practice Address - Street 1:139 GA HIGHWAY 32 BYP
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2757
Practice Address - Country:US
Practice Address - Phone:912-632-6321
Practice Address - Fax:912-632-6322
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002303225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant