Provider Demographics
NPI:1184605503
Name:KURRIE, STEPHANIE (MSPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KURRIE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 N PATTERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2946
Mailing Address - Country:US
Mailing Address - Phone:229-247-5225
Mailing Address - Fax:229-241-8471
Practice Address - Street 1:2109 N PATTERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2946
Practice Address - Country:US
Practice Address - Phone:229-247-5225
Practice Address - Fax:229-241-8471
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0076782251E1300X
GAPT007678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADC3279OtherRAILROAD MEDICARE
GAGRP3435OtherMEDICARE GROUP
GA002825OtherBLUE CROSS BLUE SHIELD
GA002825OtherBLUE CROSS BLUE SHIELD